Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in The Netherlands

Abstract

Objective-The aim of this study was to investigate prospectively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these patients have "modern treatment"-that is, early obliteration of the aneurysm and treatment with calcium antagonists-what factors cause a delay in surgical or endovascular treatment, and what the estimated eVect on outcome will be of improved treatment. Methods-A prospective, observational cohort study of all patients with aneurysmal subarachnoid haemorrhage in the hospitals of a specified region in The Netherlands. The condition on admission, diagnostic procedures, and treatments were recorded. If a patient had a clinical deterioration, the change in Glasgow coma score (GCS), the presence of focal neurological signs, the results of additional investigations, and the final diagnosed cause of the deterioration were recorded. Clinical outcome was assessed with the Glasgow outcome scale (GOS) at 3 month follow up. In patients with poor outcome at follow up, the cause was diagnosed. Results-Of the 110 patients, 47 (43%) had a poor outcome. Cerebral ischaemia, 31 patients (28%), was the most often occurring complication. Major causes of poor outcome were the eVects of the initial haemorrhage and rebleeding in 34% and 30% of the patients with poor outcome respectively. Of all patients 102 (93%) were treated with calcium antagonists and 45 (41%) patients had early treatment to obliterate the aneurysm. The major causes of delay of treatment were a poor condition on admission or deterioration shortly after admission, in 31% and 23% respectively. Conclusions-In two thirds of the patients with poor outcome the causes of poor outcome are the eVects of the initial bleeding and rebleeding. Improved treatment of delayed or postoperative ischaemia will have only minor eVects on the outcome of patients with subarachnoid haemorrhage.(J Neurol Neurosurg Psychiatry 2000;68:337-341)

Biologic Effects of Simvastatin in Patients with Aneurysmal Subarachnoid Hemorrhage: A Double-Blind, Placebo-Controlled Randomized Trial

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Microthrombosis after Aneurysmal Subarachnoid Hemorrhage: An Additional Explanation for Delayed Cerebral Ischemia

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Time course of recovery following poor-grade SAH: the incidence of delayed improvement and implications for SAH outcome study design

“…This association supports the notion that vasospasm and cerebral ischemia are significant contributors to early and late SAH-related morbidity. 18,22,26,28,29,31,42,43 It also suggests that maneuvers to avoid cerebral ischemia during hospitalization are critical in optimizing the capacity for continued long-term clinical improvement.…”