PERDARAHAN SUBARACHNOID ANEURISMA: SEBUAH LAPORAN KASUS DAN TINJAUAN LITERATUR DENGAN PENDEKATAN MANAJERIAL

Abstract

Aneurysmal subarachnoid hemorrhage is an acute neurological condition characterized by extravasation of blood into the subarachnoid space due to rupture of an intracranial aneurysm. Subarachnoid hemorrhage accounts for approximately 5% of all strokes, with high mortality and morbidity rates, especially when diagnosis and treatment are delayed. This case report presents a 66-year-old woman with generalized tonic-clonic seizures, sudden loss of consciousness, and a history of severe headache with fever. Neurological examination revealed nuchal rigidity, cranial nerve palsies, and strabismus. A non-contrast head CT revealed extensive subarachnoid hemorrhage involving almost all cerebral lobes and ventriculomegaly. The patient was diagnosed with subarachnoid hemorrhage with other complications such as stage IV CKD, anemia, and hypertension. Intensive medical management was provided, including blood pressure control with nicardipine, prevention of vasospasm with nimodipine, electrolyte correction, and neurosurgical referral for VP shunt placement. This management reflects the principles of evidence-based SAH management. This case illustrates the importance of early recognition and comprehensive management of SAH to reduce the risk of complications and death. The diagnostic and therapeutic approaches in this case align with current literature and clinical protocols for subarachnoid hemorrhage. From a hospital management perspective, this case management also emphasizes the importance of multidisciplinary collaboration, efficient clinical flow, and the use of evidence-based clinical pathways to ensure optimal care and avoid delays in diagnosis. The implementation of a quality management system and patient safety are key pillars in managing acute neurological cases, particularly in patients with complex comorbidities. This aligns with the Total Quality Management (TQM) approach, which supports continuous improvement through clinical evaluation, internal quality audits, and effective cross-unit communication. (1).