Aneurysmal subarachnoid hemorrhage. Complications and outcome in a hospital population

We describe total management results in a prospective series of 264 patients with aneurysmal subarachnoid hemorrhage (SAH) admitted to a neurologic unit. Referrals were actively solicited from general physicians as well as neurologists in the area. The diagnosis was based on computed tomography (CT). Secondary deteriorations were analyzed clinically and with serial CT scanning. Outcome was assessed 3 months after SAH. There were no relevant differences between the analyses of patients with and without an aneurysm confirmed by angiography or autopsy. One third of the patients either died within 1 day (12%) or remained in a poor clinical condition that precluded surgery (22%). One third were in good clinical condition, but contraindications to surgery were judged present or serious complications occurred before surgery could be performed. One third of all patients underwent surgery. Overall mortality in our series was 52%; only 26% made a good recovery. The risk of rebleeding was not related to the patients' initial clinical condition, but all other intracranial complications occurred significantly more often in patients graded poor compared with patients in good clinical condition. The most important causes of death and severe disability were hemorrhage (16%), recurrent hemorrhage (18%), and delayed cerebral ischemia (15%). The most important surgical complication was delayed deterioration caused by ischemia (20% of operated patients). We estimated that recognition of 'warning leaks,' surgery in patients over 65, and improvement of our surgical technique could decrease mortality from 52% to approximately 41%.