Clinical analysis of traumatic subarachnoid hemorrhage

Traumatic subarachnoid hemorrhage (TSAH) is regarded as a poor prognostic factor of primary brain stem injury. The aim of the present study is to describe the results of a clinical analysis of 15 patients with TSAH who were hospitalized between March, 1987 and April, 1990. They were classified into three groups on the basis of the initial level of consciousness evaluated by Glasgow Coma Scale (GCS) scores. Fourteen patients had TSAH in the sylvian fissures, while in five the location was the cortical sulci. Four patients had TSAH in the ambient and quadrigeminal cisterns, and another four patients had TSAH in the prepontine and interpeduncular cisterns. TSAH localized to the suprasellar cistern was found in three patients, and five patients were found to have TSAH only in the sylvian fissures. Other accompanying intracranial lesions were as follows: acute subdural hematoma in five patients. Intracerebral hematoma in four and cerebral contusion in three. Three patients, one in the severest group and two in the severe group, had fatal outcomes. The cause of death was more closely associated with the accompanying intracranial lesion than the TSAH. One patient had a fair outcome, and 11 patients had a favorable outcome. In the present study, the outcome was generally good in the patients who had TSAH in a confined area, such as the sylvian fissures or cortical sulci.