[Epidemiological, clinical and prognostic aspects of subarachnoid hemorrhage in Segovia]

Subarachnoid hemorrhage is a disorder commonly seen as a neurological emergency, with an incidence of 11-19/100,000 persons; 12% of the patients die without seeking medical attention, 63% die during the first year and 72% during the first five years.

To describe the epidemiological, clinical and prognostic factors of subarachnoid hemorrhage.

We made a retrospective study of the cases of primary subarachnoid hemorrhage occurring in the province of Segovia between January 1993 and November 1997. The patients presented with a clinical history compatible with subarachnoid hemorrhage which was confirmed by cranial CT and/or lumbar puncture. Angiography of the supra-aortic trunks was done to detect vascular malformations. The patients were classified according to clinical grades on the criteria of Hunt and Hess.

There were 54 primary subarachnoid hemorrhages (29 men and 25 women); the average age was 59 years. The average annual incidence was 7/100,000 persons; 59% were at Hunt and Hess stage I-II. Headache was the presenting symptom in 67% of the patients. The patients with normal CT scans (20%) were of lower clinical grade and consulted later; 4% had further bleeding and all these died. There were associated neurological complications in 46% and systemic complications in 28%. Of the 44 arteriographies done, in 14 there were positive findings, 11 aneurysms (five were embolized and five treated surgically), and three arteriovenous malformations (two treated surgically). On discharge 7% had severe neurological sequelae. Mortality during the acute phase was 13%.

Subarachnoid hemorrhage is still a serious condition, with a high rate of mortality during the acute phase (13%) and of sequelae (20%). The clinical grade and cranial CT findings were the main factors in prognosis.