MENA-Adapted Guidelines for Aneurysmal Subarachnoid Hemorrhage

Clinical Recommendations

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

COR 2a LOE C-LD

Adapted from AHA/ASA 2023

For new-onset seizures after aSAH, we recommend treatment with anti-seizure medication for 7 days.

Levetiracetam is preferred when available, but regional shortages may necessitate alternative medications.

COR 2b LOE C-LD

Adapted from Neurocritical Care Society

We suggest avoiding routine prophylactic anti-seizure medication in patients without seizures.

Decision should consider medication availability and cost in resource-limited settings.

COR EO-Strong LOE C

MENA-SINO Original

We strongly recommend avoiding phenytoin due to its association with poorer outcomes, using alternative agents when levetiracetam is unavailable.

Provides guidance on older, more widely available medications as alternatives to phenytoin.

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