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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 anonymous peer review
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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