Clinical practice guidelines for subarachnoid haemorrhage. Diagnosis and treatment

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

“…9,10,11,36,41 The overall mortality rate in our series was 24%, increasing to 28.2% if only SAH-A were considered, as in other series. 3,13,18,20,21,28,29 We noticed a gradual improvement in the prognosis of the overall sample, measured by the GOS, as time passed. At 12 months after the episode, 85.7% of patients who survived SAH-A and 95.4% of those with SAH-I were independent for activities of daily living (GOS 4-5), figures which slightly improve on international results.…”

“…Like the other studies, in our series the most common subtype was SAH-A (78.3%), followed by SAH-I (17.9%) and SAH-PM (3.2%). 6,10,11,20,28,29,31,32 In the case of SAH-I, the rate varies, from 19% to 12.2% depending on the study, 11,28,29,31,33 but with a downward trend over the years. Konczalla et al 33 report a low incidence of SAH-I (12%) but with an increase in the last 15 years globally, associating it with increased use of antiplatelet/anticoagulant medication.…”

“…In our series, the diagnosis was made by CT without contrast in 99.6% of the patients, with LP only required in two patients, as described in the current guidelines. 6,28,29 It should be noted that this result may be influenced by early access to hospital care, as CT in the first 24 h has a sensitivity of 95%. 24,30 CT and angiographic study provide aetiological diagnosis in 100% of cases, 30 allowing SAH to be classified into different subtypes.…”

“…Most of the aneurysms were single, located in the anterior circulation of the circle of Willis, similar to that reported in the literature. 13,28,34,35 Endovascular treatment was performed in 85% of the aneurysms, and considered to be the approach of choice in suitable patients, according to the guidelines in force at the time. 2,6,15 There has also been an increase in the surgical technique in recent years as a result of a more proactive neurosurgical team and protocolisation of the interventional treatment.…”

Hemorragia Subaracnoidea

“…El manejo terapéutico requiere cuidado neurointesivo, se recalca en el tratamiento tripe H (hipertensión, hipervolemia y hemodilución) para favorecer una adecuada presión de perfusión cerebral y así evitar el vasoespasmo, con el consiguiente infarto cerebral (7) (8).…”