Subarachnoid hemorrhage primary prevention

Jump to: navigation, search

Subarachnoid Hemorrhage Microchapters


Patient Information





Differentiating Subarachnoid Hemorrhage from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

Laboratory Findings



Other Imaging Findings

Other Diagnostic Studies


Medical Therapy


Primary Prevention

Secondary Prevention

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

Risk Factors/Prevention
Natural History/Outcome
Clinical Manifestations/Diagnosis
Medical Measures to Prevent Rebleeding
Surgical and Endovascular Methods
Hospital Characteristics/Systems of Care
Anesthetic Management
Cerebral Vasospasm and DCI
Seizures Associated With aSAH
Medical Complications

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Subarachnoid hemorrhage primary prevention On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Subarachnoid hemorrhage primary prevention

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Subarachnoid hemorrhage primary prevention

CDC on Subarachnoid hemorrhage primary prevention

Subarachnoid hemorrhage primary prevention in the news

Blogs on Subarachnoid hemorrhage primary prevention

Directions to Hospitals Treating Subarachnoid hemorrhage

Risk calculators and risk factors for Subarachnoid hemorrhage primary prevention

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


Primary prevention of subarachnoid hemorrhage is mainly aimed at treatment and modifcation of risk factors which are directly associated with increased occurrence of subarachnoid hemorrhage and noninvasive screening of patients with familial aSAH and/or patients with history of Autosomal dominant polycystic kidney disease (ADPKD).[1][2][3][4][5]

Primary Prevention

Effective measures for primary prevention of subarachnoid hemorrhage include:[1][2][3][4][5]

  • Treatment of hypertension
  • Life style modifications such as:
    • Increased physical activity in obese or over weight patients to maintain healthy weight
    • Reduced intake of sodium and increased intake of potassium
    • A diet that is rich in fruits and vegetables
    • Smoking cessation and decreased alcohal intake
    • Referral to an appropriate therapeutic program is reasonable for patients who abuse drugs
  • Noninvasive screening of patients with familial aSAH and/or patients with history of Autosomal dominant polycystic kidney disease (ADPKD)
  • Prevent head trauma
  • Identify and treat cerebral arteriovenous malformation or cerebral aneurysm

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

Risk Factors for and Prevention of aSAH: Recommendations

Class I
"1. Treatment of high blood pressure with antihypertensive medication is recommended to prevent ischemic stroke, intracerebral hemorrhage, and cardiac, renal, and other end-organ injury (Level of Evidence: A)"
"2. Hypertension should be treated, and such treatment may reduce the risk of aSAH (Level of Evidence: B)"
"3. Tobacco use and alcohol misuse should be avoided to reduce the risk of aSAH (Level of Evidence: B)"
"4. After any aneurysm repair, immediate cerebrovascular imaging is generally recommended to identify remnants or recurrence of the aneurysm that may require treatment (Level of Evidence: B)"
Class IIb
"1. In addition to the size and location of the aneurysm and the patient’s age and health status, it might be reasonable to consider morphological and hemody- namic characteristics of the aneurysm when discuss- ing the risk of aneurysm rupture (Level of Evidence: B)"
"2. Consumption of a diet rich in vegetables may lower the risk of aSAH (Level of Evidence: B)"
"3. It may be reasonable to offer noninvasive screening to patients with familial (at least 1 first-degree relative) aSAH and/or a history of aSAH to evaluate for de novo aneurysms or late regrowth of a treated aneurysm, but the risks and benefits of this screening require further study (Level of Evidence: B)"


  1. 1.0 1.1 1.2 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage
  2. 2.0 2.1 Etminan N, Beseoglu K, Steiger HJ, Ha ̈nggi D. The impact of hyper- tension and nicotine on the size of ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry. 2011;82:4–7.
  3. 3.0 3.1 Clarke M. Systematic review of reviews of risk factors for intracranial aneurysms. Neuroradiology. 2008;50:653– 664.
  4. 4.0 4.1 Feigin VL, Rinkel GJ, Lawes CM, Algra A, Bennett DA, van Gijn J, Anderson CS. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005;36: 2773–2780.
  5. 5.0 5.1 Lovelock CE, Rinkel GJ, Rothwell PM. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology. 2010;74:1494–1501.