From the Research
Patients with traumatic subarachnoid hemorrhage (SAH) and subdural hematoma should typically avoid travel for at least 4-6 weeks after injury, depending on the severity and clinical course. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of clinical stability and follow-up imaging before travel clearance 1. Initial travel clearance requires clinical stability, including normal intracranial pressure, resolution of acute symptoms, and follow-up imaging showing stabilization or improvement of the bleeds. For air travel specifically, patients should wait until cleared by their neurosurgeon due to pressure changes that could exacerbate symptoms or complications.
Prior to travel, patients should be neurologically stable, off sedation, have well-controlled pain, and demonstrate no progression of the bleeds on repeat imaging. Medications like anticonvulsants (such as levetiracetam 500-1000mg twice daily) should be continued as prescribed, and patients should travel with a companion, carry medical documentation, and ensure access to neurosurgical care at their destination. The timing recommendation is based on the natural history of blood resorption and the highest risk period for complications like rebleeding, vasospasm, and seizures occurring within the first few weeks after injury.
Some key considerations for travel clearance include:
- Clinical stability, including normal intracranial pressure and resolution of acute symptoms
- Follow-up imaging showing stabilization or improvement of the bleeds
- Neurological stability, including no progression of the bleeds on repeat imaging
- Well-controlled pain and no need for sedation
- Access to neurosurgical care at the destination
- Travel with a companion and carrying medical documentation
Individual clearance is essential as recovery timelines vary significantly based on bleed size, location, patient age, and comorbidities 2. The management of traumatic subarachnoid hemorrhage and subdural hematoma requires a multidisciplinary approach, including neurosurgeons, neurointensivists, and other specialists 3, 4. By prioritizing clinical stability and follow-up imaging, patients with traumatic SAH and subdural hematoma can minimize their risk of complications and ensure a safe and successful recovery.