Cerebral Aneurysms Follow-up

Updated: Oct 13, 2017
  • Author: David S Liebeskind, MD, FAAN, FAHA, FANA; Chief Editor: Helmi L Lutsep, MD  more...
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Follow-up

Further Outpatient Care

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  • After hospital discharge, continue physical, occupational, and speech therapy.
  • Administer medications for vasospasm and to prevent complications such as seizures, urinary tract infections, or venous thromboses.
  • Following definitive treatment of a cerebral aneurysm with either endovascular or surgical obliteration, serial imaging studies should be obtained as an outpatient. Various imaging modalities, including CTA, 1.5 or 3T MRA, and conventional angiography may be used. The use of noninvasive angiographic techniques for serial evaluation has grown in recent years. [17]
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Further Inpatient Care

Following neurosurgical or endovascular intervention, continued care in the ICU generally includes the following:

  • Serial neurologic examinations
  • Avoidance of hypotension or hypertension (mean arterial pressure [MAP] should be in the range of 70-130 mm Hg)
  • Use of isotonic solutions, such as normal saline, to minimize cerebral edema
  • Treatment or prophylaxis of seizures
  • Treatment of urinary tract infections
  • Prevention of venous thrombosis
  • Prophylaxis for gastric ulcers
  • Physical, occupational, and speech therapy
  • Repeat CT scan in case of clinical deterioration
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Inpatient & Outpatient Medications

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  • Nimodipine for vasospasm
  • Phenytoin for prevention or treatment of seizures
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Transfer

Immediately after prehospital evaluation and emergent stabilization, transfer patients with aneurysmal SAH to a center with neurosurgical expertise.

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Deterrence/Prevention

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  • Prevention of neurological injury necessitates definitive treatment of a diagnosed cerebral aneurysm.
  • Patient education regarding symptoms of aneurysmal rupture may be important, as 10% of individuals die before reaching medical attention.
  • Noninvasive screening with CTA or MRA is important in patients with medical conditions associated with cerebral aneurysms or a family history of SAH or aneurysms.
  • Recent data showing superior functional outcomes and reduced complications for those on statins prior to aneurysmal SAH may promote the use of statins.
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Complications

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  • Vasospasm
  • Recurrent hemorrhage
  • Seizures
  • Hydrocephalus
  • Hyponatremia
  • Cardiac arrhythmia, myocardial infarction, or congestive heart failure
  • Neurogenic pulmonary edema, pneumonia, or atelectasis
  • Gastrointestinal bleeding
  • Anemia
  • Venous thromboembolism
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Prognosis

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  • Prognosis of aneurysmal SAH has been associated with the following:
    • Age
    • Neurological status on admission
    • Aneurysm location
    • Number of days after SAH of admission (ie, delay from SAH to hospital admission)
    • Presence of hypertension and other medical illnesses
    • Degree of vasospasm
    • Degree of SAH
    • Extent of intraparenchymal or intraventricular hemorrhage
  • Outcome assessments following aneurysmal SAH may not be properly evaluated with the use of a single scale or measure. Cognitive dysfunction and subjective experience of recovery should also be considered.
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Patient Education

See the list below:

  • Educate regarding the warning signs and symptoms of SAH.
  • Educate regarding potential risk factors for aneurysmal SAH, including the following:
    • Hypertension
    • Cigarette smoking
    • Illicit drug use
    • Alcohol
  • For excellent patient education resources, visit eMedicineHealth's Headache Center. Also, see eMedicineHealth's patient education article, Brain Aneurysm.
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