Subarachnoid hemorrhage, Curhat

sbenernya advis bliau simpel aja: “..rawat px ini dgn best medical management..”
..tapi sperti apa “best medical management” itu? 
*storm in my mind 
(langsung browsing..)

Diagnosis of Subarachnoid Hemorrhage,Time to Change the Guidelines? |
Time-Dependent Test Characteristics of Head Computed Tomography in Patients Suspected of Nontraumatic Subarachnoid Hemorrhage |
Stroke: New guidelines for subarachnoid haemorrhage |
In patients presenting with acute headache and a normal head CT ≤6 hours after ictus, as interpreted by experienced neuroradiologists, there is no added value of CSF analysis. In patients with an atypical presentation without headache and in patients presenting >6 hours after ictus, CSF analysis is still indicated.
*agak bingung, tapii…mnarik, mnarik

trus, utk treatment-nya,
..ada nggak, guideline bwt non-aneurysmal SAH? apa gabung sama guideline ICH? (yg terbaru kalo nggak salah yg thn 2010?)

*paling sebel sama jurnal berbayar.. -_-”

SAH from medscape, outline-nya itu lho…. (utk komplikasi n treatment-nya) suka! ^o^ 

..ttg vasospasme, apa ndak bisa dx dgn klinis, apa hrs dgn TCD n imejing y?
nemu artkl “Defining Vasospasm After Subarachnoid Hemorrhage, What Is the Most Clinically Relevant Definition?”, thn 2009:
(1) symptomatic vasospasm, defined as clinical deterioration deemed secondary to vasospasm after other causes were eliminated; (2) delayed cerebral ischemia (DCI), defined as symptomatic vasospasm, or infarction on CT attributable to vasospasm; (3) angiographic spasm, as seen on digital subtraction angiography; and (4) transcranial Doppler (TCD) spasm, defined as any mean flow velocity >120 cm/sec.
ternyata konklusinya: DCI is a more clinically meaningful definition than either symptomatic deterioration alone or the presence of arterial spasm by angiography or TCD.
tapi tetep aja, “gimana kita tahu ada DCI?” ^^’a

dan..
“Despite recent advances in the treatment of patients after subarachnoid hemorrhage, morbidity and mortality rates have failed to improve significantly. Although this was often blamed on vasospasm, is it time to consider alternative etiologies?
Early brain injury (EBI) is a recently described term that describes the immediate injury to the brain after subarachnoid hemorrhage.” — Subarachnoid Hemorrhage, Is It Time for a New Direction?, 2009