Basic algorithm for management of patients with aneurysmal subarachnoid hemorrhage

Aneurysmal subarachnoid hemorrhage (aSAH) is one of the most urgent clinical conditions among neurologic diseases. If untreated, the disease has high mortality and morbidity, and the outcome depends mostly on optimal diagnostic and treatment procedure. Currently, no national guidelines for the management of aSAH have been published or accepted in Croatia. Th erefore, treating procedures depend on individual estimation, knowledge and experience, as well as on technical facilities available at diff erent medical institutions. On the other hand, by accepting a uniform approach in the management of aSAH, according to the specifi c conditions in Croatian medical institutions, reaching optimal outcome for each patient will be accomplished. Th e aim of this algorithm is to defi ne the basic characteristics of the disease, its epidemiologic data as well as its clinical picture, and to present appropriate diagnostic algorithm in accordance with specifi c facilities of diff erent medical institutions. Furthermore, this algorithm will consider optimal management of a patient with verifi ed aSAH in prehospital and hospital conditions, and fi nally in a Comprehensive Stroke Center. In addition, it will focus on the endovascular management of ruptured aneurysms and on the complications of subarachnoid hemorrhage. Th is algorithm is based on the already published international guidelines for aSAH management as well as on own experience in treating ruptured aneurysms and subarachnoid hemorrhage at the Referral Center for Intensive Neurology of the Croatian Ministry of Health during a fi ve-year period (2007-2012, altogether 515 patients). Th e level of evidence of these guidelines is, according to the classifi cation, Level A, grade I to Level C, grade IIb.