Initial Evaluation - Subarachnoid Hemorrhage

Noncontrast CT is initial study of choice and usually demonstrates hemorrhage if obtained within 72 h. LP is required for diagnosis of suspected SAH if CT is nondiagnostic; xanthochromia of the spinal fluid is seen within 6-12 h after rupture and lasts for 1-4 weeks.
Cerebral angiography is necessary to localize and define the anatomic details of the aneurysm and to determine if other unruptured aneurysms exist; angiography should be performed as soon as possible after diagnosis of SAH.
ECG may reveal ST-segment and T-wave changes similar to cardiac ischemia; caused by circulating catecholamines and excessive discharge of sympathetic neurons. A reversible cardiomyopathy producing shock or congestive heart failure may result.
Studies of coagulation and platelet count should be obtained, with rapid correction indicated if SAH is documented.

Treatment: Subarachnoid Hemorrhage

For a more detailed discussion, see Hemphill JC III, Smith WS, and Gress DR: Neurologic Critical Care, Including Hypoxic-Ischemic Encephalopathy and Subarachnoid Hemorrhage. Chap. 330, p. 1777, in HPIM-19.

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