The late prognosis of subarachnoid haemorrhage

Abstract

The results are reported of a follow-up study of the survivors of 312 cases of subarachnoid haemorrhage occurring between 1944 and 1949. Of the 172 patients who survived the initial illness, 170 have been traced, 120 being still alive two to eleven years later. Recurrent subarachnoid haemorrhage has occurred in 40 patients (23.5%) with a fatal outcome in 35 (20.6%), of whom 13 were tales and 22 females; half of the fatal recurrences occurred within six months of the initial episode. Exertion did not play a significant part in the provocation of recurrent bleeding. Four patients made an incomplete recovery from the illness and died after intervals varying from five months to twelve years. Eleven patients died of unrelated conditions. Of the surviving patients, five (4%) are completely disabled, but the remaining 115 (96%) are able to pursue some useful activity; 79 (66%) have returned to their previous employment, 24 (20%) to lighter work, and 12 (10%) have retired. Only 36 patients (30%) are completely symptom-free; in half of the remainder (33%) symptoms are relatively trivial, but in the others (33%) they are disabling. Important residua include paralytic manifestations (10%), epilepsy (12.5%), headaches (36.6%, severe and persistent in 13.1 %), mental symptoms presumed to be of organic origin (9%, severe in 4%), and anxiety symptoms (26.6%). Five patients (4%) have required surgical treatment either owing to enlargement of an aneurysm or angioma or because of repeated attacks of bleeding. It is shown that the physical and mental sequelae of this illness are similar to those of severe head injury. Graduated activity is advised during the first few months after the haemorrhage, but, since there is no evidence to show that restriction of activity is of value in preventing recurrence, patients should be encouraged to live a normal life. Undue caution is valueless and may be positively harmful. Confident reassurance is an essential part of rehabilitation, and may even require the assertion that recurrent bleeding will not occur. Management along these lines is likely to reduce the incidence of psychoneurotic sequelae. © 1952, British Medical Journal Publishing Group. All rights reserved.