MENA-Adapted Guidelines for Aneurysmal Subarachnoid Hemorrhage

Clinical Recommendations

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

COR 1 LOE A

Adapted from AHA/ASA 2023

We strongly recommend nimodipine administration for all aSAH patients to prevent delayed cerebral ischemia.

Given variable accessibility and cost across MENA countries, contingency approaches are provided for limited supply situations.

COR 2a LOE B-R RL

Adapted from ESO Guidelines

For symptomatic delayed cerebral ischemia, we recommend blood pressure augmentation and volume expansion.

Protocols should be adapted for facilities lacking continuous arterial monitoring, using intermittent non-invasive measurements.

COR EO-Strong LOE C RL

MENA-SINO Original

In settings with limited advanced monitoring, we strongly recommend simplified protocols for detecting and managing delayed cerebral ischemia.

Emphasizes clinical assessment and basic monitoring when advanced neuromonitoring is unavailable.

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