Articles  |   April 2019
ACE Question
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Education / CPD / Articles
Articles   |   April 2019
ACE Question
ASA Monitor 4 2019, Vol.83, 45.
ASA Monitor 4 2019, Vol.83, 45.
A 55-year-old man is under your care in the intensive care unit three days after rupture and urgent coiling of an anterior cerebral artery aneurysm. Which of the following prophylactic interventions is most appropriate to decrease the risk of delayed cerebral ischemia?
Patients suffering from aneurysmal subarachnoid hemorrhage (SAH) are at risk for delayed cerebral ischemia, often being ascribed to vasospasm. This complication occurs in up to 40 percent of patients surviving the initial hemorrhage, and is the primary cause of mortality if the hemorrhage progresses to infarction. The time course for delayed ischemia overlaps the time course for rebleeding (Figure 1). This has led to early aneurysm repair and prophylactic treatment for delayed ischemia/vasospasm. Nimodipine is currently the only class 1, level A intervention to improve outcomes. Guidelines from the American Heart Association, the American Stroke Association, the Neurocritical Care Society, and the European Stroke Organization support its universal use in SAH.
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