Untreated subarachnoid hemorrhage: who, why, and when?

Area of Science:

• Neurosurgery
• Neurology
• Vascular Medicine

Background:

• Subarachnoid hemorrhage (SAH) typically requires surgical or endovascular intervention.
• A subset of SAH patients do not receive definitive treatment, necessitating characterization of this group.

Purpose of the Study:

• To identify and characterize patients with SAH who do not undergo treatment.
• To compare outcomes between treated and untreated SAH patients and among different subgroups of untreated patients.

Main Methods:

• Retrospective review of SAH patients admitted to a tertiary care center over 9 years.
• Classification of untreated patients into groups based on angiographic findings (normal, none obtained, abnormal).
• Comparison of demographic, clinical, neuroimaging, and outcome data.

Main Results:

• 166 of 643 SAH patients were untreated. Untreated patients were older, had worse neurological status, and higher mortality (43.4% vs. 11.7%).
• Untreated patients with normal angiograms (n=76) had low mortality (6.6%).
• Patients without angiography (n=52) had the highest mortality (92.3%). Those with abnormal angiograms (n=38) had 50% mortality, often from rebleeding. Treatment improved outcomes in elderly and severely impaired patients.

Conclusions:

• A significant proportion of SAH patients are not treated, primarily due to normal angiograms or poor clinical grade.
• Untreated patients with normal angiograms have good outcomes; those not undergoing angiography or with abnormal findings face high mortality.
• While treatment appears beneficial for high-risk groups, definitive conclusions require prospective randomized trials.