Nonaneurysmal Subarachnoid Hemorrhage: A Review of Clinical Course and Outcome in Two Hemorrhage Patterns

Linda L. Herrmann; Joseph M. Zabramski


J Neurosci Nurs. 2007;39(6):135-142. 

In This Article

Medical Management

Management of patients with SAH includes admission to the intensive care unit for close observation of neurological status, vital signs, and cardiac function. Careful observation is necessary to evaluate for increased headache, alteration in level of consciousness, extremity weakness, changes in speech, or other neurologic deficits. Blood pressure parameters in these patients are usually set to maintain systolic blood pressure (SBP) parameters less than 140 mm Hg. In hypertensive patients, IV medications such as nicardipine can be titrated to maintain these parameters. An external ventricular drain (EVD) is placed in patients with CT evidence of hydrocephalus or a depressed level of consciousness.

Daily evaluation of laboratory chemistries is recommended to monitor for hyponatremia, a common complication of SAH. To maintain a sodium level greater than 135 mEq/L, patients may need oral sodium supplementation (1 or 2 grams three times a day with meals) or IV 1.5%–3% sodium chloride at 30–50 cc per hour, along with adequate fluid replacement. After sodium replacement has been initiated, the sodium value is monitored frequently, often two to four times daily until the level is stable and until supplementation is weaned.

Nimodipine is initiated on admission in all patients with SAH for the prevention and treatment of vasospasm (Feigin, Rinkel, Algra, Vermeulen, & van Gijn, 1998; Rinkel et al., 2005). However, after NASAH has been identified, nimodipine is discontinued, because the incidence of vasospasm is low in this population (Brismar & Sundbarg, 1985; Rinkel, Wijdicks, Vermeulen, et al., 1991; van Gijn et al., 1985). Symptom management includes the use of appropriate analgesics or nonpharmacological modalities for headache management, nuchal rigidity, nausea, emesis, and constipation.