Safeguarding or stabilization of vital functions (respiration, body temperature, circulation).
Avoidance of recurrent hemorrhage (new bleeding/post-bleeding) (often in the first 24 hours).
Reduction of intracranial pressure
Avoidance of complications, v. a. hydrocephalus (pathological dilation of the fluid spaces (cerebral ventricles) of the brain filled with cerebrospinal fluid), vasospasms (vascular spasms) and epileptic seizures (convulsions)
Therapy recommendations
Sedation (immobilization of the patient)
Analgesia (pain relief)
Blood pressure management
Target range for normotensive patients: 120-140 mmHg.
Target range for hypertensive patients: 130-160 mmHg
In hydrocephalus (pathological dilation of the fluid spaces (cerebral ventricles) of the brain filled with cerebrospinal fluid):
In occlusive hydrocephalus (hydrocephalus occlusus): CSF drainage via external ventricular drainage (EVD).
In chronic occlusive hydrocephalus: surgical insertion of a ventriculoperitoneal (drainage into the abdominal cavity) or ventriculoartial (drainage into the right atrium) shunt
If epileptic symptoms are present: anticonvulsive therapy (“anti-seizure” drug therapy).
In case of hematoma (subdural or intraparenchymatous): neurosurgical hematomevacuation (hematoma evacuation).
Thrombosis (blood clots): after aneurysm care with low molecular weight heparins (subcutaneous).
Caveat: Prophylactic administration of glucocorticoids and antifibrinolytics is not indicated!
Low-dose (75-300 mg/day) continuous medication with acetylsalicylic acid (ASA; antiplatelet agent), as prescribed in primary and secondary prevention of vascular events, does not increase the risk of intracranial hemorrhage. In fact, a protective (protective) effect was observed for subarachnoid hemorrhage.