MENA-Adapted Guidelines for Aneurysmal Subarachnoid Hemorrhage

Clinical Recommendations

Evidence-based recommendations adapted for MENA healthcare settings, organized by clinical domain.

COR 1 LOE B-NR RL

Adapted from AHA/ASA 2023

We strongly recommend frequent neurological assessments using validated tools to monitor for delayed cerebral ischemia.

Assessment frequency should be adapted to available nursing resources while maintaining safety standards.

COR 1 LOE B RL

Adapted from NICE Guidelines

For patients with neurological deterioration, we recommend urgent CT imaging to determine the cause.

Protocols for urgent imaging access should be established, including after-hours availability.

COR EO-Strong LOE C RL

MENA-SINO Original

We strongly recommend training nursing staff in standardized neurological assessment techniques with clear escalation protocols.

Training programs should be developed in local languages with consideration for varying educational backgrounds.

1 Strong recommendation - Should be performed

2a Moderate recommendation - Reasonable to perform

2b Weak recommendation - May be considered

A High-quality evidence from multiple RCTs

B Moderate evidence from single RCT or observational studies

C Expert opinion or case studies

RL Resource-Limited - Requires adaptation for limited resources

EO Expert Opinion - MENA-SINO consensus recommendation