Guidelines for the management of aSAH clinical manifestations and diagnosis

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AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (2012)

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Sara Mehrsefat, M.D. [2]

2012 AHA/ASA Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage[1]

Clinical Manifestations and Diagnosis of aSAH: Recommendations

Class I
"1. aSAH is a medical emergency that is frequently misdiagnosed. A high level of suspicion for aSAH should exist in patients with acute onset of severe headache (Level of Evidence: B)"
"2. Acute diagnostic workup should include noncontrast head CT, which, if nondiagnostic, should be followed by lumbar puncture (Level of Evidence: B)"
"3. DSA with 3-dimensional rotational angiography is indicated for detection of aneurysm in patients with aSAH (except when the aneurysm was previously diagnosed by a noninvasive angiogram) and for planning treatment (to determine whether an aneurysm is amenable to coiling or to expedite microsurgery) (Level of Evidence: B)"
Class IIa
"1. CTA may be considered in the workup of aSAH. If an aneurysm is detected by CTA, this study may help guide the decision for type of aneurysm repair, but if CTA is inconclusive, DSA is still recommended (except possibly in the instance of classic perimesen- cephalic aSAH) (Level of Evidence: C)"
"2. Magneticresonanceimaging (fluid-attenuatedinversion recovery, proton density, diffusion-weighted imaging, and gradient echo sequences) may be reasonable for the diagnosis of aSAH in patients with a nondiagnostic CT scan , although a negative result does not obviate the need for cerebrospinal fluid analysis (Level of Evidence: C)"


References

  1. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839

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