The overall outcomes of a subarachnoid hemorrhage: A retrospective review of two hundred and twenty-five emergency cases

Abstract

To investigate the overall management results of moribund cases of a subarachnoid hemorrhage (SAH), 225 consecutive patients who were admitted to the Emergency Medical Center of Kyorin University from 1989 to 1993 were retrospectively analyzed. About half of these patients were hospitalized within one hour from the onset of the hemorrhage and 95% within 6 hours. Their neurological condition on admission was categorized according to the Hunt and Kosnik grading scale, with 17% of the patients assigned to grade 4 and, 64% assigned to grade 5, respectively. About 40% of the patients manifested abnormal pupillary findings and also presented ataxic or apneic respiratory pattern on admission. Among this studied patient-population, 24% of the patients were admitted in the 'dead on arrival' condition. The SAH diagnosis in 80% of the patients was achieved on the basis of their CT findings, and the balance on the basis of a postmortem spinal or suboccipital cisternal puncture. A ruptured aneurysm was verified in 46% of all patients and radical surgery was accomplished in 34% of all patients. The overall management mortality amounted to 75% and a favorable outcome was achieved in 14% of the patients. The major causes of a poor outcome were primary brain damage due to a rupture of the aneurysm, rebleeding from the aneurysm, and/or acute respiratory failure. The prognosis of patients who had ischemic events after the ictus was definitely worse, and their mortality rate was more than 90%. Based on these findings, the authors have concluded that conventional management yielded a limited outcome and that only prophylactic treatment of an unruptured aneurysm has the possibility of improving the overall prognosis of a SAH.