Intracranial aneurysm and non-traumatic subarachnoid hemorrhage

Abstract

The rupture of intracranial aneurysms account for 80% of non-traumatic intracerebral hemorrhages. When bleeding occurs, it is necessary to assess the possible neuronal damage associated with both ischemia and extrinsic compression, so the initial measures are aimed at strict control of blood pressure (BP) to ensure adequate cerebral perfusion pressure (CPP) with drugs such as nimodipine. If a hemorrhage occurs of such a caliber that it increases or could increase the intracranial pressure (ICP) alarmingly and puts the patient's life at risk, it will be necessary to perform an emergent decompressive craniotomy with evacuation of the hematoma while promoting controlled hypotension of the patient to decrease bleeding. In the case of intact aneurysms, treatment can be performed endovascularly with coils or they can be resected in the operating room, again requiring a certain degree of local hypotension to prevent bleeding. Traumatic intracranial hemorrhages will be surgical if they affect the patient's clinical status or are located in regions where increased ICP could cause brain herniation. Its treatment will be carried out by trepanotomy in case of being epidural or subdural, the rest can benefit from a craniotomy. In these cases, in addition to measures to prevent bleeding, specialized airway management is especially important, which is usually associated with cervical instability in a large number of cases.