Clinical Recommendations

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

Diagnosis & Assessment

COR 1 LOE B-R RL
Adapted from AHA/ASA 2023

We strongly recommend immediate neurological assessment and CT angiography for patients with suspected aSAH to confirm diagnosis and identify aneurysm location.

MENA-Specific Considerations

CT angiography availability varies across MENA countries. Telemedicine consultation should be utilized for image interpretation where local expertise is limited.

COR 1 LOE B-NR
Adapted from NICE Guidelines

For patients with negative CT but high clinical suspicion, we recommend lumbar puncture or MRI to exclude aSAH.

MENA-Specific Considerations

MRI availability is limited in many MENA settings. Lumbar puncture remains the primary alternative when CT is negative.

COR EO-Strong LOE C RL
MENA-SINO Original

In resource-limited settings, we strongly recommend establishing clear protocols for urgent patient transfer to centers with neurovascular expertise.

MENA-Specific Considerations

Transfer protocols must account for geographic barriers, security concerns in conflict zones, and family involvement in decision-making.

Recommendation Grading System

Class of Recommendation (COR)

1 Strong recommendation - Should be performed
2a Moderate recommendation - Reasonable to perform
2b Weak recommendation - May be considered

Level of Evidence (LOE)

A High-quality evidence from multiple RCTs
B Moderate evidence from single RCT or observational studies
C Expert opinion or case studies

Special Designations

RL Resource-Limited - Requires adaptation for limited resources
EO Expert Opinion - MENA-SINO consensus recommendation