Case Scenario for Fluid Management After Subarachnoid Hemorrhage in the Neuro-Intensive Care Unit

Subarachnoid hemorrhage is a cerebrovascular emergency with significant morbidity and mortality. The clinical presentation varies; most patients present with severe headache, nausea, vomiting and neck pain. Loss of consciousness can also happen in severe cases. Early diagnosis is essential and confirmed with a non-contrast CT of the brain with or without a lumbar puncture. The most common cause of nontraumatic subarachnoid hemorrhage is aneurysm rupture. Most patients with aneurysmal subarachnoid hemorrhage should be monitored closely in an intensive care unit after securing the aneurysm, to monitor for and prevent potential neurological and medical complications. Neurological complications include aneurysm rerupture, seizures, hydrocephalus, intracranial hypertension, and delayed cerebral ischemia, all of which can worsen outcome following subarachnoid hemorrhage. Systemic complications that can occur in these patients include acute cardiopulmonary decompensation (i.e. neurogenic pulmonary edema, estress cardiomyopathy, etc.), and hyponatremia secondary to cerebral salt wasting syndrome or syndrome of inappropriate antidiuretic hormone secretion. Close neurologic and hemodynamic monitoring and understanding of the pathophysiologic changes of this complex patient population is important to optimize patient outcome.