Subarachnoid hemorrhage - Revision history

Danbot: Embed Ottawa SAH Calculator on clinical page

2026-03-22T09:56:22Z

Embed Ottawa SAH Calculator on clinical page

← Revisión anterior		Revisión del 09:56 22 mar 2026
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	== Calculators ==		== Calculators ==
			{{Ottawa SAH Calculator}}
	{{Fisher Scale Calculator}}		{{Fisher Scale Calculator}}

Danbot: Embed Fisher Scale Calculator on clinical page

2026-03-22T09:55:55Z

Embed Fisher Scale Calculator on clinical page

← Revisión anterior		Revisión del 09:55 22 mar 2026
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	*Transfer to neurosurgical center if local capabilities unavailable		*Transfer to neurosurgical center if local capabilities unavailable
	*SAH ruled out (negative CT + negative LP): may discharge with headache precautions and PCP follow-up		*SAH ruled out (negative CT + negative LP): may discharge with headache precautions and PCP follow-up

			== Calculators ==
			{{Fisher Scale Calculator}}

	==See Also==		==See Also==

Danbot: Strip excess bold text - keep only critical safety emphasis

2026-03-22T09:22:58Z

Strip excess bold text - keep only critical safety emphasis

Show changes

Danbot: Major update: Ottawa SAH Rule, CT sensitivity by time, Hunt-Hess grade, LP xanthochromia timing, nimodipine for vasospasm, nicardipine for BP, aminocaproic acid, references with PMIDs

2026-03-21T19:54:34Z

Major update: Ottawa SAH Rule, CT sensitivity by time, Hunt-Hess grade, LP xanthochromia timing, nimodipine for vasospasm, nicardipine for BP, aminocaproic acid, references with PMIDs

Show changes

Danbot: Move calculators to own section with header (visible in TOC), expanded, before External Links

2026-03-21T15:07:05Z

Move calculators to own section with header (visible in TOC), expanded, before External Links

← Revisión anterior		Revisión del 15:07 21 mar 2026
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	*[[Lumbar Puncture]]		*[[Lumbar Puncture]]
	*[[EBQ:Differentiation between traumatic tap and aneurysmal subarachnoid hemorrhage]]		*[[EBQ:Differentiation between traumatic tap and aneurysmal subarachnoid hemorrhage]]

			== Calculators ==
			{{Fisher_Scale_Calculator}}

	==External Links==		==External Links==
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	==References==		==References==
	<references/>		<references/>

	~~<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">~~
	~~<div style="font-weight:bold;">📊 Modified Fisher Scale Calculator [show]</div>~~
	~~<div class="mw-collapsible-content">~~
	~~{{Fisher_Scale_Calculator}}~~
	~~</div>~~
	~~</div>~~
	[[Category:Neurology]]		[[Category:Neurology]]

Danbot: Add Modified Fisher Scale calculator (collapsible)

2026-03-21T13:42:42Z

Add Modified Fisher Scale calculator (collapsible)

← Revisión anterior		Revisión del 13:42 21 mar 2026
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	==References==		==References==
	<references/>		<references/>

			<div class="mw-collapsible mw-collapsed" style="border:1px solid #aaa; padding:5px; margin-top:10px;">
			<div style="font-weight:bold;">📊 Modified Fisher Scale Calculator [show]</div>
			<div class="mw-collapsible-content">
			{{Fisher_Scale_Calculator}}
			</div>
			</div>
	[[Category:Neurology]]		[[Category:Neurology]]

Danbot: Add MedicationDose entry (nimodipine) with SMW annotations

2026-03-20T18:31:40Z

Add MedicationDose entry (nimodipine) with SMW annotations

← Revisión anterior		Revisión del 18:31 20 mar 2026
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	{{AHA SAH BP Guidelines}}		{{AHA SAH BP Guidelines}}


			==Medication Dosing==
			{{MedicationDose
			\| drug = Nimodipine
			\| dose = 60mg q4hr
			\| route = PO or NGT
			\| context = Vasospasm prevention; start within 96hr of onset
			\| indication = Subarachnoid hemorrhage
			\| population = Adult
			\| notes = Never give IV; NNT 13 to prevent one poor outcome; monitor BP
			}}

	==Disposition==		==Disposition==

Elcatracho: /* Management */

2021-02-24T02:36:55Z

Management

← Revisión anterior		Revisión del 02:36 24 feb 2021
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	#[[Seizure]] prophylaxis		#[[Seizure]] prophylaxis
	#*Controversial; 3 day course may be preferable		#*Controversial; 3 day course may be preferable
	#*[[Phenytoin]], [[levetiracetam]], [[carbamazepine]] and [[phenobarb]]. Phenytoin can be associated with worse neurologic & cognitive outcome		#*[[Phenytoin]], [[levetiracetam]], [[carbamazepine]] and [[phenobarb]]. Phenytoin can be associated with worse neurologic & cognitive outcome{{Citation needed\|reason=Reliable source needed\|date=FEBRUARY 2021}}
	#[[Glucocorticoid]] therapy		#[[Glucocorticoid]] therapy
	#*Controversial; evidence suggests is neither beneficial nor harmful		#*Controversial; evidence suggests is neither beneficial nor harmful

Elcatracho: /* See Also */

2021-01-18T21:18:42Z

ClaireLewis at 16:17, 3 October 2019

2019-10-03T16:17:42Z

← Revisión anterior		Revisión del 16:17 3 oct 2019
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	===Risk Factors===		===Risk Factors===
	*Genetics (polycystic kidney disease, Ehler-Danlos, family history)		*Genetics (polycystic kidney disease, Ehler-Danlos, family history)
	*Hypertension		*[[Hypertension]]
	*Atherosclerosis		*Atherosclerosis
	*Cigarette smoking		*Cigarette smoking
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	*[[Meningitis]]		*[[Meningitis]]
	*[[Encephalitis]]		*[[Encephalitis]]
	*Intracranial tumor		*[[brain tumor\|Intracranial tumor]]
	*Intracranial hypotension		*Intracranial hypotension
	*Metabolic derangements		*[[Metabolic derangements]]
	*[[Cerebral venous thrombosis]]		*[[Cerebral venous thrombosis]]
	*Primary headache syndromes (benign thunderclap headache, [[Migraine]], [[Cluster Headache]])		*Primary headache syndromes (benign thunderclap headache, [[Migraine]], [[Cluster Headache]])
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	*Can exclude SAH if all of the following are true		*Can exclude SAH if all of the following are true
	**Age < 40		**Age < 40
	**No ~~Neck~~ pain or stiffness		**No neck pain or stiffness
	**No ~~Witnessed~~ LOC		**No witnessed LOC
	**No onset during exertion		**No onset during exertion
	**No ~~Thunderclap~~ symptomatology (max intensity at onset)		**No thunderclap symptomatology (max intensity at onset)
	**No limited neck flexion on physical exam		**No limited neck flexion on physical exam

	'''If concerned for SAH and CT normal strongly consider LP, especially if CT obtained >6 hrs after symptom onset'''		'''If concerned for SAH and CT normal strongly consider LP, especially if CT obtained >6 hrs after symptom onset'''

	===Non-Contrast Head CT===		===Non-Contrast [[Head CT]]===
	{\| class="wikitable"		{\| class="wikitable"
	\| align="center" style="background:#f0f0f0;"\|'''Time from onset of symptoms'''		\| align="center" style="background:#f0f0f0;"\|'''Time from onset of symptoms'''
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	*SAH due to trauma - look at convexities of frontal and temporal cortices		*SAH due to trauma - look at convexities of frontal and temporal cortices

	===Lumbar Puncture===		===[[Lumbar Puncture]]===
	*Elevated RBC count that does not decrease from tube one to four		*Elevated RBC count that does not decrease from tube one to four
	**Note: decreasing RBCs in later tubes can occur in SAH; only reliable if RBC count in final tube is nl		**Note: decreasing RBCs in later tubes can occur in SAH; only reliable if RBC count in final tube is nl
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	==Management==		==Management==
	Physiologic derangements, such as hypoxemia, metabolic acidosis, hyperglycemia, BP instability, and fever, can worsen brain injury and has been independently associated with increased M&M, but no studies showing benefit of corrections.		Physiologic derangements, such as [[hypoxemia]], [[metabolic acidosis]], [[hyperglycemia]], BP instability, and [[fever]], can worsen brain injury and has been independently associated with increased M&M, but no studies showing benefit of corrections.

	#Avoid hypotension		#Avoid [[hypotension]]
	#*Maintain MAP>80 (CPP of 60 as long as ICP<20)		#*Maintain MAP>80 (CPP of 60 as long as ICP<20)
	#*Give [[IVF]]		#*Give [[IVF]]
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	#*[[Aspirin]] → [[DDAVP]]		#*[[Aspirin]] → [[DDAVP]]
	#*[[Plavix]] → [[Platelets]]		#*[[Plavix]] → [[Platelets]]
	#*~~Dabigitran (~~[[~~Pradaxa~~]]) → [[Idarucizumab]] (Praxbind): 5 grams IV		#*[[Dabigatran]] (Pradaxa) → [[Idarucizumab]] (Praxbind): 5 grams IV
	#[[Nimodipine]]		#[[Nimodipine]]
	#*Only CCB studied that has been shown improve outcomes (contrary to popular belief, it does not affect large-vessel vasospasm but does decrease incidence of delayed cerebral ischemia)<ref>Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care. 2016;20(1):277.</ref>		#*Only CCB studied that has been shown improve outcomes (contrary to popular belief, it does not affect large-vessel vasospasm but does decrease incidence of delayed cerebral ischemia)<ref>Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care. 2016;20(1):277.</ref>
	#*Give 60mg q4hr PO or NGT only (never IV) within 96hr of symptom onset. NNT 13 to prevent one poor outcome		#*Give 60mg q4hr PO or NGT only (never IV) within 96hr of symptom onset. NNT 13 to prevent one poor outcome
	#*Keep an eye on BP for fluctuations		#*Keep an eye on BP for fluctuations
	#[[~~Magneisum~~ sulfate]]		#[[Magnesium sulfate]]
	#*Controversial; prevents vasospasm acting as NMDA antagonist and a calcium channel blocker; maintain between 2-2.5 mmol/L		#*Controversial; prevents vasospasm acting as NMDA antagonist and a calcium channel blocker; maintain between 2-2.5 mmol/L
	#Seizure prophylaxis		#[[Seizure]] prophylaxis
	#*Controversial; 3 day course may be preferable		#*Controversial; 3 day course may be preferable
	#*[[Phenytoin]], [[levetiracetam]], [[carbamazepine]] and [[phenobarb]]. Phenytoin can be associated with worse neurologic & cognitive outcome		#*[[Phenytoin]], [[levetiracetam]], [[carbamazepine]] and [[phenobarb]]. Phenytoin can be associated with worse neurologic & cognitive outcome
	#Glucocorticoid therapy		#[[Glucocorticoid]] therapy
	#*Controversial; evidence suggests is neither beneficial nor harmful		#*Controversial; evidence suggests is neither beneficial nor harmful
	#Glycemic control		#Glycemic control
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	===Cardiac abnormalities===		===Cardiac abnormalities===
	Most likely related to the release of catecholamines due to hypoperfusion of hypothalamus		Most likely related to the release of catecholamines due to hypoperfusion of hypothalamus
	*Ischemia		*[[myocardial ischemia\|Ischemia]]
	**Elevated [[troponin]] (20-40% of cases)		**Elevated [[troponin]] (20-40% of cases)
	**ST segment depression		**ST segment depression
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	*Deep, symmetric TWI		*Deep, symmetric TWI
	*Prominent U waves		*Prominent U waves
	===Hydrocephalus===
			===[[Hydrocephalus]]===
	*Consider ventricular drain placement for deteriorating LOC + no improvement within 24hr		*Consider ventricular drain placement for deteriorating LOC + no improvement within 24hr

← Revisión anterior		Revisión del 21:18 18 ene 2021
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	*[[Intracranial Hemorrhage (Main)]]		*[[Intracranial Hemorrhage (Main)]]
	*[[Head Trauma]]		*[[Head Trauma]]
			*[[Lumbar Puncture]]
			*[[EBQ:Differentiation between traumatic tap and aneurysmal subarachnoid hemorrhage]]

	==External Links==		==External Links==