Medicina Intensiva Medicina Intensiva
Med Intensiva 2008;32:342-53 - Vol. 32 Núm.7 DOI: 10.1016/S0210-5691(08)76212-0
Puesta al día en Medicina Intensiva: Neurointensivismo
Manejo general en Cuidados Intensivos del paciente con hemorragia subaracnoidea espontánea
General management in intensive care of patient with spontaneous subarachnoid hemorrhage
F. Guerrero Lópeza,, , C.M. de la Linde Valverdeb, F.I. Pino Sáncheza
a Servicio de Cuidados Críticos y Urgencias. Medicina Intensiva. Hospital Universitario Virgen de las Nieves. Granada. España
b Servicio de Anestesiología y Reanimación. Hospital de Rehabilitación y Traumatología. Hospital Universitario Virgen de las Nieves. Granada. España
Aceptado 22 mayo 2008
Resumen

Aneurysmal subarachnoid hemorrhage (SAH) is a neurologic emergency and often a neurologic catastrophe. Nontraumatic subarachnoid hemorrhage is characterized by the extravasation of blood into the spaces covering the central nervous system. The leading cause of SAH is rupture of an intracranial aneurysm, which accounts for about 80-85% of cases. Mortality and morbidity can be reduced if SAH is treated urgently. Sudden, explosive headache is a cardinal but nonspecific feature in the diagnosis of SAH; computered tomography (CT) scanning is mandatory in all the patients with symptoms that are suggestive of SAH. Catheter angiography for detecting aneurysms is gradually being replaced by CT angiography. Diagnosing SAH can be challenging and treatment is complex, sophisticated and multidisciplinary. Rebleeding is the most imminent danger, which must be prevented by endovascular occlusion with detachable coils (coiling) or by surgical clipping of the aneurysm; the risk of delayed cerebral ischemia is reduced with nimodipine and avoiding hypovolemia; hydrocephalus can be treated by ventricular drainage. Intensive care plays a more important role in the management of SAH than in any other neurological disorder. Excellence in neurologic diagnosis, in operative neurosurgery or neuroradiologic procedures must be accompanied by excellence in Intensive Care.

This review emphasizes treatment in the Intensive Care Unit, surgical and endovascular therapeutic options and the current state of treatment of major complications such as rebleeding, cerebral vasospasm and acute hydrocephalus.

Palabras clave
hemorragia subaracnoidea, aneurisma intracraneal, vasoespasmo intracraneal, hidrocefalia, nimodipino, embolización terapéutica, doppler transcraneal
Key words
subarachnoid hemorrhage, intracranial aneurysm, vasospasm intracranial, hydrocephalus, nimodipine, embolization therapeutic, ultrasonography doppler transcranial
Med Intensiva 2008;32:342-53 - Vol. 32 Núm.7 DOI: 10.1016/S0210-5691(08)76212-0