Subarachnoid hemorrhage remains a challenging disease, with ongoing controversy surrounding several key aspects (including the optimal diagnostic pathway and management of vasospasm).
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The IBCC chapter is located 👉 here.
- The podcast & comments are below.
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Hi Josh,
This is a great addition to the IBCC. I was wondering specifically about the dose and frequency of the levetiracetam for seizure prophylaxis.
Are you using 1g BD or larger doses in these cases?
Thanks for your help
Dean
As a bolus we do levetiracetam 2-3 gr followed by levetiracetam 1 gr twice a day (1,5 g if patients > 80 kg)
What about using CT perfusion to recognize reversible ischemia vs ischemia progressing to infarction? Anyone using it?https://link.springer.com/article/10.1007/s00234-015-1543-3
extraordinary… Carber, I thought the loading dose of keppra is 20-30 mg/kg, which I guess is the 2-3gms you use. Josh , great chapter. there is so much here I (embarrassingly ) was not aware of. the LP still seems to be a thorn… thunderclap h/a 8-10 hours ago. CT non con, CT angio head and neck both negative … no LP needed? (I do not suspect meningitis). suppose. headache severe for 24 hours? not sure my lab can detect xanthochromia. patch trial.. platelets bad. DDAVP good for patients on asa., plavix. and TXA ! for platelet “enhancement”, but not… Read more »
I experienced a Suburachnoid Hemmorage nearly 20 years ago. I was having severe Vertigo for which I could not walk a straight line to get in my bathroom, I visited my Doctor because I felt like I was dying, and my Doctor couldn’t find the problem. The very next morning, I awoke with the most loud painfully headache it was off the charts like thunder in my heads. I ran to get my husband and I ran out of the house telling him to run every red light and don’t stop for anything, we made it to the Hospital in… Read more »
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Hi there!
Martín, ICU and Internal Medicine Physician from Buenos Aires, Argentina.
What are your thoughts about the efficacy of cilostazol in prevention of delayed cerebral
Ischemia after aneurysmal SAH?
Do you use it routinely?
Thanks!
2022 AHA guidelines intermediate Grade 2a level to support to their recommendations for intensive BP lowering to a systolic BP target <140 mm Hg within 6 hours of symptom onset to reduce hematoma expansion and improve functional outcome after ICH [1, 2]. Thoughts? Is there enough evidence for this reccomendation yet especially given the INTERACT1-3 trials? our neurosurgeons are recommending it.