SAH

Question 1

Clipping vs. Coiling

Answer 1

• ISAT Trial (2002): Coiling is more likely to result in independent survival at 1 year than neurosurgical clipping for patients with ruptured intracranial aneurysms suitable for both treatments.

Question 2

Hypertension Treatment

Answer 2

• NEWTON-2 (2020): High-intensity versus low-intensity blood pressure control did not result in a significant reduction in the risk of disability after aneurysmal subarachnoid hemorrhage.

Question 3

Management of Vasospasm

Answer 3

• CONSCIOUS-1 (2008): Clazosentan, an endothelin receptor antagonist, significantly reduced angiographic vasospasm after aneurysmal subarachnoid hemorrhage, but did not result in an improved clinical outcome.
• MASH-2 (2010): Use of prophylactic magnesium did not improve clinical outcomes in aneurysmal subarachnoid hemorrhage.

Question 4

Hydrocephalus Management

Answer 4

• ISRCTN trial (2004): The use of lumbar drainage for reducing vasospasm and delayed ischemic neurological deficits in patients with aneurysmal subarachnoid hemorrhage, although promising, needs further study to confirm its efficacy.

Question 5

Nimodipine Use

Answer 5

• MRC trial (1989): Nimodipine significantly reduces the incidence of cerebral infarction and improves outcome after subarachnoid hemorrhage.