Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is a severe, potentially fatal condition. This article presents a translated summary of the 2023 American Heart Association/American Stroke Association (AHA/ASA) guideline, offering comprehensive recommendations spanning diagnosis, treatment, and recovery for aSAH patients. For diagnosis, clinical grading scales (Hunt-Hess, WFNS) should be used to assess initial severity. The diagnostic pathway depends on headache onset timing (before or after 6 hours) to determine whether noncontrast CT alone suffices or lumbar puncture is needed; the Ottawa SAH rule aids risk stratification. DSA is indicated when CTA is negative but suspicion remains high, or to plan intervention strategy. For aneurysm treatment, complete aneurysm obliteration should occur as early as possible, ideally within 24 hours. The choice between coiling and clipping depends on aneurysm location, patient age, and anatomical features—generally, coiling is preferred for posterior circulation aneurysms and low-grade patients suitable for either technique, while clipping may be preferred in younger patients. Adjunctive techniques such as stents and flow diverters are used for complex cases (wide-neck, fusiform aneurysms). For complication management, oral nimodipine is the primary measure to prevent delayed cerebral ischemia (DCI) and improve functional outcomes; statins and intravenous magnesium are not recommended. Vasospasm should be monitored via TCD and CTA/CTP; symptomatic vasospasm is managed with induced hypertension, intra-arterial vasodilators, or angioplasty as needed. Acute hydrocephalus requires urgent CSF drainage; seizure prophylaxis is reserved for high-risk patients, avoiding prolonged phenytoin use. For rehabilitation, early and ongoing screening for cognitive impairment, depression, anxiety, and sexual dysfunction is essential, alongside early multidisciplinary rehabilitation. Finally, patients post-aneurysm treatment require periodic vascular imaging surveillance to detect recurrence or new aneurysm formation, particularly in high-risk groups (younger age, family history, multiple aneurysms, female sex).
