Introduction: Subarachnoid hemorrhage (SAH) is a disease with high morbidity and mortality even with optimal treatment, and 85% of SAH is caused by ruptured aneurysm. The effects are very debilitating to the patient and their family. Symptomatic vasospasm, which often occurs in 20 – 40% of patients with SAH, is responsible for numerous deaths or sequelae in patients with SAH. We want to present our case series on SAH patients with suspected symptomatic vasospasm and share our experience on detecting the symptomatic vasospasm through Glasgow Coma Score and thorough neurological examination
Case presentation: We gathered 4 case series in patients with SAH diagnosed clinically and head computed tomography (CT) scan from April to July 2022. The exclusion criteria were traumatic SAH, age under 18 years, and admission above 14 days after symptom onset. We assessed the Hunt Hess grading scale. All patients received emergency treatment followed by surgeries and got intravenous nimodipine from the first day in inpatient. All patients had uncontrolled hypertension and unknown relatives with aneurysms or similar conditions. All patients underwent emergency cerebrospinal fluid diversion surgery on day 1. Follow-up CT scan after deterioration revealed no rebleeding, and laboratory results (electrolyte, glucose, blood gas analysis) were unremarkable.
Conclusion: Early treatment and management in an emergency setting are keys to stabilization. Correction of any non-neurological factor is also essential. Despite the maximum effort in the treatment of care, early identification of any risk factors and probably neurovascular screening could be the most effective solution for preventing SAH caused by a ruptured aneurysm or arteriovenous malformation.
Keywords: subarachnoid hemorrhage, symptomatic vasospasm