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Review and recommendations on management of refractory raised intracranial pressure in aneurysmal subarachnoid hemorrhage

Authors Mak CHK, Lu YY, Wong GKC

Received 7 March 2013

Accepted for publication 6 June 2013

Published 11 July 2013 Volume 2013:9 Pages 353—359

DOI https://doi.org/10.2147/VHRM.S34046

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 5


Calvin Hoi Kwan Mak, Yeow Yuen Lu, George Kwok Chu Wong

Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong

Abstract: Intracranial hypertension is commonly encountered in poor-grade aneurysmal subarachnoid hemorrhage patients. Refractory raised intracranial pressure is associated with poor prognosis. The management of raised intracranial pressure is commonly referenced to experiences in traumatic brain injury. However, pathophysiologically, aneurysmal subarachnoid hemorrhage is different from traumatic brain injury. Currently, there is a paucity of consensus on the management of refractory raised intracranial pressure in spontaneous subarachnoid hemorrhage. We discuss in this paper the role of hyperosmolar agents, hypothermia, barbiturates, and decompressive craniectomy in managing raised intracranial pressure refractory to first-line treatment, in which preliminary data supported the use of hypertonic saline and secondary decompressive craniectomy. Future clinical trials should be carried out to delineate better their roles in management of raised intracranial pressure in aneurysmal subarachnoid hemorrhage patients.

Keywords: aneurysm, intracranial pressure, intracranial hypertension, subarachnoid hemorrhage

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