What to do about subarachnoid hemorrhage in the elderly

For subarachnoid hemorrhage in elderly patients, the following measures can be taken:

1. Immediate assessment and stabilization of vital signs: The primary goal is to ensure the patient's life safety, including maintaining respiration, circulation, and consciousness. Endotracheal intubation and mechanical ventilation may be necessary, along with blood pressure control to prevent exacerbation of bleeding due to elevated blood pressure.

2. Emergency medical attention: Subarachnoid hemorrhage is a neurosurgical emergency requiring immediate hospitalization for detailed examinations to determine the cause and severity of the bleeding.

3. Imaging studies: Urgent head CT scan should be performed, which is the preferred method for diagnosing SAH and can rapidly identify the location and extent of the hemorrhage. If CT is negative but SAH is clinically suspected, lumbar puncture should be performed to examine the cerebrospinal fluid.

4. Identifying the cause of bleeding: Most cases of SAH are caused by rupture of intracranial aneurysms. Further investigations such as angiography or MRI/MRA are needed to determine the exact cause and guide subsequent treatment.

5. Intracranial pressure control: Medications to reduce intracranial pressure, such as mannitol, should be used to alleviate symptoms like headache and vomiting and to prevent brain herniation.

6. Antifibrinolytic therapy: Antifibrinolytic agents such as tranexamic acid may be used to inhibit fibrinolysis and prevent rebleeding.

7. Surgical treatment: If the hemorrhage is caused by an aneurysm or cerebral vascular malformation, cerebral angiography may be required to confirm the diagnosis, followed by surgical interventions such as aneurysm clipping or endovascular embolization, depending on the specific circumstances.