Presentation - ruptured (most common cause of intracranial hemorrhage):

• headache
• nausea and vomiting
• focal neurological signs
• depressed consciousness
• ECG - sinus bradycardia, T abnormality (may mimic myocardial ischemia)

Hunt and Hess classification of subarachnoid hemorrhage

Cerebral vasospasm

• occurs generally 3-4 days after bleed
• major cause of morbididy
• diagnosis
  • transcranial Doppler positive before symptoms:
  • worsening headache
  • hypertension
• treatment - "triple H"
  1. hypervolemia
  2. hypertension
  3. hemodilution

Management of Anesthesia

• Goals
  • prevent increased blood pressure
  • facilitate surgical exposure
  • maintain euvolemia
• temporary occlusive clips on aneurysm afferents with normal or slightly elevated blood pressure probably better than controlled hypotension (and no clips)
• consider thiopental "protection"

CEA Aneurysm Tumor Apnea Cord References
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