Management of non-traumatic subarachnoid hemorrhage in Filipinos

A retrospective study of a consecutive series of 110 Filipino patients with non-traumatic subarachnoid hemorrhage (SAH) treated by the author in an urban setting is presented as to etiology, sex and age, diagnostic procedures employed, and short- and long-term results of non-surgical and surgical management. Aneurysms were the source of hemorrhage in 48%, arteriovenous malformation in 9%, and "other SAH" (hypertension/undetermined causes) in 43%. Fifty-seven (52%) patients were initially seen by a general practitioner, 44 (40%) by a neurologist, and only nine (8%) were seen directly by the neurosurgeon. A male sex preponderance for aneurysm was seen below the age of 50 years and a female preponderance for other SAH and aneurysm above age 50 years. The great majority of patients were admitted on the same day they had SAH--usually within 8 hours of onset. Delay in hospitalization did not adversely affect the clinical grade. SAH was demonstrated by lumbar puncture (71%) and computed tomography (29%). Of 74 patients who underwent angiography, vasospasm was associated mainly with aneurysms and present in 50% of these cases. Medications most commonly utilized were for control of edema, sedation, and anti-vasospasm. Forty-three of 53 patients with aneurysms underwent surgical procedures of various types. In general, patients admitted with good clinical grade had good outcomes of treatment. For high grade patients the attitude was to wait for an improvement in clinical grade before performing surgery.