• Alexandra BIBIRITA University Emergency Hospital of Bucharest
  • D. TELEANU University Emergency Hospital of Bucharest
  • M.S. MOREANU “Carol Davila” University of Medicine and Pharmacy, Bucharest
  • A.V. CIUREA “Carol Davila” University of Medicine and Pharmacy, Bucharest


Aneurysmal subarachnoid hemorrhage is the most dramatic form of hemorrhagic stroke. This pathology should not be regarded as a single disease, but rather as a set of events that happen in a chain-like manner, with devastating complications and requirement of proper management from the beginning. Material and methods: We conducted an observational and retrospective study on a group of 47 patients treated for aneurysmal HSA, with secured aneurysm, over a period of 2 years. Results: Patients who underwent surgery within the first 5 days of presentation by external ventricular drainage required shorter hospitalization and had faster social reintegration and better neurorehabilitation. Conclusions: The main cause of complications leading to coma or death in patients hospitalized for aneurysmal HSA is symptomatic vasospasm. Various surgical methods are currently used to prevent vasospasm, while others are still under development. We believe that an early approach to the subarachnoid space by opening the cerebrospinal fluid passage is mandatory for a better clinical outcome.

Author Biographies

Alexandra BIBIRITA, University Emergency Hospital of Bucharest

Neurosurgery I Clinic

D. TELEANU, University Emergency Hospital of Bucharest

Neurosurgery I Clinic
“Carol Davila” University of Medicine and Pharmacy, Bucharest

A.V. CIUREA, “Carol Davila” University of Medicine and Pharmacy, Bucharest

“Sanador” Clinical Hospital of Bucharest
Neurosurgical Department


1. Kameda-Smith M, Aref M, Jung Y, Ghayur H, Farrokhyar F. Determining the diagnostic utility of lumbar punctures in CT negative suspected subarachnoid hemorrhage: A Systematic Review and Meta-analysis. World Neurosurg 2020; 148: e27-e34.
2. Wu L, Chen G. Signaling Pathway in Cerebral Vasospasm After Subarachnoid Hemorrhage: News Update. Acta Neurochir Suppl 2016; 121: 161-165.
3. Kodama N, Sasaki T, Kawakami M, Sato M, Asari J. Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients. Surgical Neurology 2000; 53(2): 110-117.
4. Perry JJ, Alyahya B, Sivilotti MLA, et al. Differentiation between traumatic tap and aneurysmal subarachnoid hemorrhage: prospective cohort study. BMJ 2015; 350: h568 / doi: 10.1136/bmj.h568.
5. Chu K, Hann A, Greenslade J, Williams J, Brown A. Spectrophotometry or visual inspection to detect xanthochromia most reliably in subarachnoid hemorrhage: systematic review. Ann Emerg Med 2014; 64: 256-264.
6. Almeida S, Nogueira MB, Raboni SM, Vidal LR. Laboratorial diagnosis of lymphocytic meningitis, Braz J Infect Dis 2007: 11(5): 489-495.
7. von Holst H, Mathiesen T. Electrolyte concentrations in serum and CSF following subarachnoid haemorrhage. Br J Neurosurg 1990; 4(2): 123-126.
8. Joerk A, Seidel RA, Walter SG, et al. Impact of heme and heme degradation products on vascular diameter in mouse visual cortex. J Am Heart Assoc 2014; 3(4): e001220 / doi: 10.1161/JAHA.114.001220.
9. Peter S, Václav B, Shahaf L, et al. Subarachnoid Hemorrhage Increases Level of Heme Oxygenase-1 and Biliverdin Reductase in the Choroid Plexus. Front Cell Neurosci 2020; 14: 593305/ doi: 10.3389/ fncel.2020.593305
10. Borkar S, Manmohanjit S, Kale S, et al. Spinal cerebrospinal fluid drainage for prevention of vaso-spasm in aneurysmal subarachnoid hemorrhage: A prospective, randomized controlled study. Asian Journal of Neurosurgery 2018; 13: 238-246.
11. Suzuki H, Shiba M, Nakatsuka Y. Higher Cerebrospinal Fluid pH may Contribute to the Development of Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage. Transl Stroke Res 2017; 8: 165-173.
12. Bibiriță A, Teleanu D, Ciurea AV. Subarachnoid hemorrhage. A critical neurosurgical emergency. Romanian Neurosurgery 2021: 35(2): 129-134.
13. Nguyen AM, Nguyen Dao LT, Thai TT, Cerebrospinal fluid lumbar drainage in reducing vasospasm following aneurysmal subarachnoid hemorrhage in Vietnam: A single-center prospective study. In-terdisciplinary Neurosurgery 2021; 25: 101175.
14. Olson DM, Zomorodi M, Britz GW, Zomorodi AR, Amato A, Graffagnino C. Continuous cerebral spinal fluid drainage associated with complications in patients admitted with subarachnoid hemorrhage. J Neurosurg 2013; 119(4): 974-980.