Systemic complications of aneurysmal subarachnoid hemorrhage

🔺Hypovolemia

🔺Hyponatremia

🔺Hypokalemia

🔺Hypocalcemia

🔺Electrocardiographic abnormalities

🔺Pulmonary edema

🔺Pneumonia

🔺Pulmonary embolus

🔺Hepatic dysfunction

🔺Renal dysfunction

🔺Thrombocytopenia

🔺Gastrointestinal bleeding

INTRACRANIAL ANEURYSMS : GENETICS AND ASSOCIATED DISEASES

Of patients who have SAH from ruptured aneurysm, 5% to 10% will have one or more first-order relatives who have also had a ruptured aneurysm. 

The inheritance is probably dominant with variable penetrance. 

Conditions associated with intracranial aneurysms include 〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰〰

🏷polycystic kidney disease (5% of aneurysms series, 33% of polycystic kidney series)

🏷coarctation of the aorta (1% of aneurysm patients, 5% of coarctation patients, all of whom are hypertensive)

🏷sickle cell disease

🏷drug abuse (cocaine: generalized vasoconstriction and hypertension; intravenous use: mycotic aneurysms)

🏷hypertension (30% to 40% of patients with SAH). 

Rarer associations 

〰〰〰〰〰〰〰

🏷fibromuscular dysplasia

🏷Marfan's syndrome

🏷tuberous sclerosis

🏷Ehlers-Danlos syndrome

🏷hereditary hemorrhagic telangiectasia

🏷moyamoya disease

🏷pseudoxanthoma elasticum. 

🏷Choriocarcinoma 

🏷cardiac myxomas 

Ref: Handbook of Neuroanesthesia, 4th Edition, p:144

Predictors of mortality after subarachnoid hemorrhage

<Ⓜ️nemo : "POOR PreDICTOR"

P͞͞O͞͞O͞͞R͞͞  neurologic condition at hospital admission, a function of rate and volume of bleed

P͞͞R͞͞E͞͞existing illness

D͞͞epressed level of consciousness after initial bleed

I͞͞ncreased blood pressure

C͞͞irculation affected: if Basilar 

T͞͞hick clot in the brain substance or ventricles on initial computed tomographic scan

O͞͞lder age

R͞͞epeat hemorrhage