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New Brain Hemorrhage Guidelines Stress Quick Action

Hospitals with more expertise handling these attacks also boost survival outcomes

THURSDAY, Jan. 22 (HealthDay News) -- Brain hemorrhage patients have better outcomes when they're treated quickly and at hospitals that handle many brain attack emergencies, according to updated guidelines released by the American Heart Association.

Subarachnoid hemorrhage (SAH) occurs when a blood vessel bursts and bleeds into the brain's subarachnoid space -- the lining between the surface of the brain and the brain tissue. Most SAHs are caused by a ruptured aneurysm (a small, ballooned-out area of a blood vessel). Trauma to the head can also cause SAHs.

SAH is one of the most deadly neurological emergencies. The death rate for SAH is about 45 percent in the first 30 days, and about half of survivors suffer significant disability.

Since the previous guidelines were released in 1994, there have been a number of advances. Among the highlights of the new guidelines released Jan. 22:

  • Early definitive aneurysm treatment is indicated for most patients and can reduce death and disability.
  • SAH is misdiagnosed in as many as 12 percent of cases. Misdiagnosis results in a fourfold greater risk of death or disability. Patients who complain of severe headache with acute onset should be checked for SAH.
  • It's highly beneficial for SAH patients to receive care at hospitals that offer both endovascular and cerebrovascular surgical expertise. SAH patients also have significantly better outcomes when treated at hospitals with a great deal of experience treating SAH patients, compared to hospitals with little experience.
  • Catheter angiography remains the gold standard for detecting aneurysms and directing treatment.
  • Standardized emergency department protocols are necessary for managing SAH patients, particularly in the early stages.
  • Endovascular coiling (treatment of the aneurysm through a catheter) can be beneficial in certain cases. This method is often used to avoid brain surgery.

The updated guidelines were published in a recent issue of Stroke.

More information

The Brain Aneurysm Foundation has more about brain aneurysm.

-- Robert Preidt

SOURCE: American Heart Association, news release, Jan. 22, 2009

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