Criteria for eligibility | |
Inclusion criteria | |
Age above 18 years | |
SAH with an aneurysmal bleeding pattern | |
Exclusion criteria | |
Evidence of DCI after the SAH, unless symptoms of DCI started within 3 h | |
Coexisting severe head injury | |
Perimesencephalic hemorrhage | |
A history of a ventricular cardiac rhythm disorder or heart failure necessitating medical treatment | |
Likely transfer to another hospital, not participating in the trial, soon after treatment for the aneurysm | |
Moribund | |
Pregnancy | |
No informed consent or informed consent not feasible | |
Additional exclusion criteria for the sub-study on cerebral perfusion | |
Known allergy for CT contrast agents | |
Renal failure, defined as a serum creatinine > 150 μmol/L | |
Diabetes mellitus and glomerular filtration rate < 60 | |
Criteria for randomisation | |
Inclusion criteria | |
DCI based on a decrease of at least 1 point on the Glasgow Coma Scale sum score and/or the development of new focal neurological deficits according to the NIHSS, diagnosed by a neurologist, neurosurgeon, intensivist, unless the deterioration does not reflect DCI as evaluated by the treating physician | |
Exclusion criteria | |
Another cause for the neurological deterioration, e.g. | |
Increasing hydrocephalus | |
Recurrent bleeding | |
Clinical signs of epilepsy | |
Severe infectious disease with associated decrease in level of consciousness | |
Hypoglycemia, defined as serum glucose < 3.0 mmol/L | |
Hyponatremia, defined as serum sodium < 125 mmol/L | |
Metabolic encephalopathy due to renal or hepatic failure | |
Ischemia related to aneurysm treatment | |
An untreated symptomatic aneurysm | |
A spontaneous mean arterial pressure above 120 mmHg at the moment of randomization | |
Any other contraindication for induced hypertension | |
No CT-perfusion scan at time of neurological deterioration | |
More than three contrast CT scans since admission |