Patient handout

Aneurysmal SAH — Good Grade (Hunt-Hess I–III)

PRODUCTION

1. Your condition

This handout is for aneurysmal sah — good grade (hunt-hess i–iii). Your care team identified this based on: thunderclap headache, gcs 15, no/minimal focal deficit (hh i–ii) [aha/asa 2023 hoh pmid 37212182].

Other reasons your team may use this plan: drowsiness or mild focal deficit (hh iii) with thunderclap [hunt-hess 1968; aha/asa 2023]; ct showing subarachnoid blood in alert patient (fisher i–iv) [aha/asa 2023]; cta demonstrates saccular aneurysm — entry to coiling/clipping pathway [aha/asa 2023; isat 2005].

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
nimodipine	60 mg PO/NG q4h × 21 days	PO	q4h	BRANT (Pickard BMJ 1989 PMID 2496789) — Class I per 2023 AHA/ASA; reduces poor outcome from DCI. NEVER IV (FDA boxed warning — fatal hypotension).

Plan: Good-grade aSAH (HH I–III) — early securing ≤24 h + nimodipine + BP <160 pre-secure + DCI rescue (AHA/ASA 2023 + NCS 2023)

3. When to call your provider

Contact your care team if any of the following happen:

Any thunderclap → ED for re-rupture / new aneurysm (AHA/ASA 2023)
New focal deficit → STAT CT/CTA for de-novo aneurysm/AVM (AHA/ASA 2023)
PHQ-9 ≥15 or suicidal ideation → urgent psych (AHA/ASA 2023)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

HH III — drowsiness / confusion OR mild focal neurologic deficit; mortality ~10–15% [Hunt-Hess 1968]
Anterior communicating artery aneurysm — most common (~30%); risk frontal-lobe edema, hypothalamic injury → DI/SIADH, post-securing cognitive/behavioural changes
Posterior communicating artery aneurysm — CN III palsy (pupil-involving "down-and-out") is sentinel sign
MCA bifurcation aneurysm — wide-necked with M2 branch involvement common; treatment decision individualised (neither coil nor clip clearly superior — BRAT 2012)
Basilar tip / posterior circulation aneurysm — coiling clearly favoured by ISAT due to surgical access difficulty; basilar perforator injury risk(life-threatening)
Vertebral artery / PICA aneurysm — often dissecting; medullary territory infarct risk → lower-CN dysfunction affecting swallow and airway
Treatment-modality decision — coiling preferred posterior circulation (ISAT); individualised anterior; clipping for wide-neck MCA OR parenchymal hematoma evacuation
Pregnancy + good-grade aSAH — securing strategy individualised by trimester; coiling generally preferred to minimise radiation/anesthesia complexity

5. Follow-up

Cerebrovascular clinic 6 wk / 3 / 6 / 12 mo; BP <130/80 (2025 AHA/ACC HTN); smoking cessation; family aneurysm screening if ≥2 first-degree relatives or ADPKD; rehab; cognitive eval (MoCA + PHQ-9); repeat MRA at 6 mo [AHA/ASA 2023]

6. Sources

Guideline: 2023 AHA/ASA aSAH Guideline (Hoh et al, Stroke 2023 PMID 37212182) + 2023 NCS aSAH Management (Treggiari et al, Neurocrit Care 2023 PMID 37202712)