Certified Neuroscience Registered Nurse (CNRN) Practice Exam

In a patient with aneurysmal SAH awaiting treatment, what is the goal of blood pressure management?

1. Keep BP low to prevent rebleeding

2. Keep BP high to prevent vasospasm

3. Maintain normal BP levels

4. Keep BP high enough to prevent vasospasm but low enough to prevent rebleeding

The correct answer is: Keep BP high enough to prevent vasospasm but low enough to prevent rebleeding

In patients with an aneurysmal subarachnoid hemorrhage (SAH) awaiting treatment, the management of blood pressure is crucial to balance the risks of rebleeding and vasospasm. The goal is to maintain blood pressure at a level that is high enough to prevent cerebral vasospasm, a complication that can lead to delayed ischemic neurological deficits, while simultaneously avoiding excessively high blood pressure that could lead to rebleeding from the aneurysm. In this scenario, slightly higher blood pressure can help maintain cerebral perfusion in the context of potential vasospasm, which often occurs within the first week after SAH. However, there is a narrow window of acceptable blood pressure management since uncontrolled hypertension could increase the risk of rebleeding, particularly if the aneurysm has not yet been secured. Thus, the aim is to find an optimal range, generally keeping blood pressure elevated enough to mitigate the risk of vasospasm but controlled to minimize the chance of rebleeding. This careful balance reflects the complexity of SAH management and underscores the importance of tailored blood pressure strategies in these patients.