From the Research
Patients with traumatic subarachnoid hemorrhage (tSAH) should typically wait at least 7-14 days before traveling, depending on the severity of their injury and their clinical stability. This recommendation is based on the most recent and highest quality study available, which suggests that patients with mild TBI and isolated SAH generally have low morbidity and short length of stay, with less than 10% showing worsening of their head injury on repeat CT scanning 1.
Key Considerations for Travel
- Before travel is considered, patients should demonstrate neurological stability with no deterioration for several days, resolution of acute symptoms like severe headaches or altered consciousness, and follow-up imaging showing stabilization or improvement of the hemorrhage.
- For air travel specifically, patients should wait at least 2-3 weeks due to pressure changes in the cabin that could potentially exacerbate intracranial pressure.
- When travel is necessary, patients should continue prescribed medications such as analgesics, anticonvulsants if indicated, and avoid medications that increase bleeding risk like NSAIDs or anticoagulants unless specifically directed by their neurosurgeon.
- During travel, patients should stay well-hydrated, avoid alcohol, take frequent breaks during car travel, and have a companion present.
Rationale for Waiting Period
The waiting period allows time for the blood to be reabsorbed and reduces the risk of complications such as delayed vasospasm, seizures, or rebleeding that could occur in unfamiliar settings without immediate access to neurosurgical care. While studies on nimodipine treatment for cerebral vasospasm after subarachnoid hemorrhage provide valuable insights into management strategies 2, 3, 4, 5, the decision to travel should prioritize the patient's clinical stability and risk of complications.
Individualized Approach
This recommendation should be individualized based on the patient's neurological status, imaging findings, and the presence of complications. The study by 1 highlights the importance of managing patients with mild TBI and isolated SAH without routine neurosurgical consultation, but with careful monitoring and repeat CT scanning as needed. By prioritizing the patient's clinical stability and taking a cautious approach to travel, healthcare providers can minimize the risk of adverse outcomes and ensure the best possible quality of life for patients with tSAH.