Clinical profile and course of patients with subarachnoid haemorrhage for 11 years

Abstract

Introduction: Spontaneous subarachnoid haemorrhage is a rare cause of stroke, but it causes great socioeconomic impact and high morbidity and mortality. The aim of this study is to describe the clinical profile and evolution of a series of patients with SAH admitted to a tertiary hospital, as well as the diagnostic and therapeutic management.

Material and methods: Retrospective study of 536 patients diagnosed with SAH admitted to the ICU of the Hospital Universitario de A Coruña between 2003 and 2013 (Age: 56.9±14.1 years, female/male ratio: 1.5:1). Demographic characteristics, risk factors, aetiologies and clinical signs, prognostic scales, diagnostic tests and treatment were collected. A comparative analysis was made between the general series and subgroups of patients with aneurysmal (SAH-A) and idiopathic (SAH-I) subarachnoid haemorrhage.

Results: There were 49.0±15.1 patients/year (2013 incidence: 4.3/100,000 inhabitants). 60.3% presented Glasgow Coma Scale 14-15, with scarce symptomatology (Hunt-Hess I-II 61.9%, World Federation Neurosurgeons Scale I-II 60.4%). 50.7% presented Fisher IV. SAH-A was diagnosed in 78.3% (n=396); perimesencephalic subarachnoid haemorrhage (SAH-PM) in 3.2%; and SAH-I in 17.9%. During the study period there was an increase in the prevalence of aneurysms, causing an increased number of surgeries in recent years. Both SAH-A and SAH-I presented greater severity upon admission. Patients with SAH-A had higher percentage of complications and mortality, with lesser degree of independence at 6 and 12 months.

Conclusions: The incidence of SAH appears to have decreased in recent years, with SAH-I comprising 17.9% of the cases. Patients with SAH-I have better prognosis and lower risk of complications, highlighting the benignity of SAH-PM.

Keywords: Aneurisma intracraneal; Clipaje; Clipping; Hemorragia perimesencefálica; Hemorragia subaracnoidea espontánea; Intracranial aneurysm; Perimesencephalic haemorrhage; Prognosis; Pronóstico; Spontaneous subarachnoid haemorrhage; Vasoespasmo; Vasospasm.