Treatment Decision Process for Subarachnoid Hemorrhage: Guilherme Dabus, MD

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"After the diagnosis is done and we know the grade, the first thing we do is look at the CAT scan and make sure that the ventricle system, is dilated or not. If it’s more dilated, patients get sleepier and sometimes they can actually compensate and become unresponsive. They may need to have that done first."

Overall, about 20% of strokes are hemorrhagic, with subarachnoid hemorrhage and intracerebral hemorrhage each accounting for 10%. A subarachnoid hemorrhage is defined as the accumulation of blood in the space between the arachnoid membrane and the pia mater around the brain referred to as the subarachnoid space. About 85% of nontraumatic subarachnoid hemorrhage cases are secondary to aneurysmal rupture, with the remaining 15-20% having an undefined mechanism of bleeding.

The primary symptom of subarachnoid hemorrhage is sudden, severe headache. Along with headache, patients may experience other symptoms of nausea, vomiting, stiff neck, problems with vision, and brief loss of consciousness. In general, management include medical measures and interventional options like endovascular coiling or direct surgical clipping of the IA. Typically, the key goals for patients with subarachnoid hemorrhage are the prevention of rebleeding, delayed cerebral ischemia, supportive care, pain management, and accurate diagnosis and treatment.

To learn more about the complexities with treating subarachnoid hemorrhage, NeurologyLive® sat down with Guilherme Dabus, MD, codirector of interventional neuroradiology and vice-chief of the department of neuroscience at Baptist Health Miami Neuroscience Institute. Dabus, an expert in stroke care, provided his thoughts on how subarachnoid hemorrhage presents, and the different types of responses clinicians can take. Furthermore, he spoke on the importance of timing, and instances when surgery should be recommended.