Systemic Complications Following SAH

Q: All of the following are likely to be the complications of SubArachnoid Hemmorhage (SAH) EXCEPT?

A) Rebleeding

B) Vasospasm 

C) Increased intracranial pressure (ICP)

D) Seizures

E) Hypernatremia

Answer: E

Vasospasm is the most dreaded and dramatic complication of SAH, but fortunately, it can be managed in the ICU, where 24/7 care is provided. About one out of five patients experience it, particularly with diffuse SAH.

Rebleeding and Increased ICP are also expected, and usually successfully managed in the ICU.

Prescription of anti-seizure medications is the norm.

All complications from Choices A to D are expected in NASAH, but hyponatremia is expected instead of hypernatremia. Interestingly, the occurrence of hyponatremia increases the risk of vasospasm.

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References:

1. Gillespie CS, Mihaela-Vasilica A, Dhaliwal J, Lee KS, Henney AE, Veremu M, Chedid Y, Roman E, Al-Nusair L, Ekert JO, China M, Cook WH, Alam AM, Ashraf M, Funnell JP, Grandidge C, Best L, Matloob S. Hyponatremia Incidence After Subarachnoid Hemorrhage and Association with Outcomes: Systematic Review and Meta-Analysis. World Neurosurg. 2025 Mar;195:123616. doi: 10.1016/j.wneu.2024.123616. Epub 2025 Jan 31. PMID: 39732459.

2. Garg R, Bar B. Systemic Complications Following Aneurysmal Subarachnoid Hemorrhage. Curr Neurol Neurosci Rep. 2017 Jan;17(1):7. doi: 10.1007/s11910-017-0716-3. PMID: 28168536.