Spontaneous subarachnoid haemorrhage and ruptured aneurysms in the Middle East. A myth revisited

The difficulties and controversies regarding the incidence of spontaneous subarachnoid haemorrhages (SSH) and ruptured intracranial aneurysms in the Middle East prompted the revision of the experience in the State of Qatar, considering the unique and favourable conditions provided by its size and Health Care System. Methodological sources of error such as diagnostic criteria and referral pattern were carefully scrutinized and evaluated. The incidence of both entities were in fact lower than any western reported values: 2.69 spontaneous subarachnoid haemorrhages and 1.04 ruptured aneurysms per 100000 inhabitants/year. This value remained low even when estimated values for possible underdiagnosing errors were added. Age, sex, population at risk and the low incidence of some risk factors are probably related to the values found.