Subarachnoid hemorrhage primary prevention

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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]

Overview

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)"

References

  1. 1.0 1.1 1.2 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage http://stroke.ahajournals.org/content/early/2012/05/03/STR.0b013e3182587839
  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.

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