Abstract
One hundred patients with spontaneous subarachnoid hemorrhage due to aneurysm or presumed aneurysm consecutively admitted to a neurological clinic and subjected to CCT during the first 72 hours were examined retrospectively. The outcome after two months as defined by the Glasgow Outcome Scale (GOS) was relatively good: 23% of the patients suffered management mortality (GOS I) (postoperative lethality 8%), 3% showed GOS-Grade II, 14% grade III, 17% grade IV, and 43% grade V. The extent of intracranial hemorrhage correlated well with the initial Hunt-Hess Grade which, in turn, had a strong influence on case fatality and the degree of disability. Lethal factors were: 1. massive subarachnoid hemorrhage together with a massive ventricular hemorrhage (p<0.001),2. massive subarachnoid hemorrhage together with an intracerebral hematoma>20 ml (p<0.05). Case fatality was lower when angiography was negative. In our study rebleeding (12%) and delayed cerebral ischemia (DCI) (18%) were less frequent and the lethality due to acute hydrocephalus (5%) and delayed cerebral ischemia (5%) was less pronounced than in comparable studies. The degree of disability (GOS) was directly related to the amount of intracranial blood, to the development of acute or chronic hydrocephalus, delayed cerebral ischemia and rebleeding. DCI occurred in 60% of patients with marked hydrocephalus. Rebleeding was more frequent in patients with acute hydrocephalus. Hydrocephalus, DCI, and rebleeding were associated with a poorer initial grade on the Hunt and Hess Scale.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Adams HP Jr, NF Kassel, JC Torner: usefulness of computed tomography in predicting outcome after aneurysmal subarachnoid hemorrhage: A preliminary report of the cooperative aneurysm study. Neurology 35 (1985) 1263–1267
Adams HP, NF Kassell, JC Torner, EC Haley Jr: Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: CT results and antifibrinolytic therapy. A report of the Cooperative Aneurysm Study. Neurology 37 (1987) 1586–1591
Alvord EC Jr, RB Thorn: Natural history of subarachnoid hemorrhage: early prognosis. Clin Neurosurg 24 (1977) 167–175
Aoyagi N, J Hayakawa: Analysis of 223 ruptured aneurysms with special reference to rupture. Surg Neurol 21 (1984) 445–452
Black PM, A Tzouras, L Foley: Cerebrospinal fluid dynamics and hydrocephalus after experimental subarachnoid hemorrhage. Neurosurgery 17 (1985) 57–62
Black PM: Hydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysm. Neurosurgery 18 (1986) 12–16
Bonita R, S Thomson: Subarachnoid hemorrhage: Epidemiology, diagnosis, management and outcome. Stroke 16 (1985) 591–594
Brott T, TI Mandybur: Case-control study of clinical outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery 19 (1986) 891–895
Cancilla PA JC Torner, DW Nibbelink: Pathological results from patients who died in a randomized study (Phase II), in subarachnoid hemorrhage: Report of the Cooperative Study. Urban & Schwarzenberg, Baltimore (1981) 277–284
Disney L, B Weir, M Grace, Canadian Nimodipine Study Group: Factors influencing the outcome of aneurysm rupture in poor grade patients: A prospective series. Neurosurgery 23 (1988) 1–9
Dóczi T, Z Nemessányi, Z Szeguáry, E Huszka: Disturbances of cerebrospinal fluid circulation during the acute stage of subarachnoid hemorrhage. Neurosurgery 12 (1983) 435–438
Fisher CM, JP Kistler., JM Davis: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomography scanning. Neurosurgery 6 (1980) 1–9
Galera RE, T Greitz: Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms. J Neurosurg 32 (1976) 634–641
van Gijn J, A Hijdra, EFM Wijdicks, M Vermeulen, H van Crevel: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurgery 63 (1985) 355–362
van Gijn J, KJ van Dongen, M Vermeulen A Hijdra: Perimesencephalic hemorrhage: A nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology 35 (1985) 493–497
Graff-Radford NR, J Torner, HP Adams, NF Kassell: Factors associated with hydrocephalus after subarachnoid hemorrhage. A report of the cooperative aneurysm study. Arch Neurol 46 (1989) 744–752
Gurusinghe NT, AE Richardson: The value of CT in aneurysmal subarachnoid hemorrhage. The concept of a CT score. J Neurosurg 60 (1984) 763–770
Hasan D, M Vermeulen, EFM Wijdicks, A Hijdra, J van Gijn: Management problems in acute hydrocephalus after subarachnoid hemorrhage. Stroke 20 (1989) 747–753
Heros RC, NT Zervas, V Varsos: Cerebral vasospasm after subarachnoid hemorrhage: An update. Ann Neurol 14 (1983) 599–608
Heros RC: Acute hydrocephalus after subarachnoid hemorrhage. Stroke 20 (1989) 715–717
Hildebrandt G, M Werner, M Kaps, O Busse: Acute non-communicating hydrocephalus after spontaneous subarachnoid hemorrhage. Acta Neurochir Wien 75 (1985) 58–61
Hijdra A, JV Gijn: Early death from rupture of an intracranial aneurysm. J Neurosurg 57 (1982) 765–768
Hijdra A, J van Gijn, S Stefanko, KJ van Dongen, M Vermeulen, H van Crevel: Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: Clinicoanatomic correlations. Neurology 36 (1986) 329–333
Hijdra A, R Braakman, J van Gijn, M Vermeulen, H van Crevel: Aneurysmal subarachnoid hemorrhage. Complications and outcome in a hospital population. Stroke 18 (1987) 1061–1067
Hijdra A, J van Gijn, NJD Nagelkerke M Vermeulen, H van Crevel: Prediction of delayed cerebral ischemia, rebleeding and outcome after aneurysmal subarachnoid hemorrhage. Stroke 19 (1988) 1250–1956
Ingall TJ, JP Whisnant, DO Wiebers, WM, O'Fallon: Has there been a decline in subarachnoid hemorrhage mortality?. Stroke 20 (1989) 718–724
Jennett B, M Bond: Assessment of outcome after severe brain damage. A practical scale. Lancet 1 (1975) 480–484
Kassell NF, JC Torner: The international cooperative study on timing of aneurysm Surgery —An update. Stroke 15 (1984) 566–570
Kassell NF, T Sasaki, ART Colohan, G Nazar: Cerebral vasospasm following aneurysmal subarachnoid hemorrhage. Stroke 16 (1985) 562–572
Kistler JP, RM Crowell, KR Davis, R Heros, RG Ojemann, T Zervas, CM Fisher: The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: A prospective study. Neurology 33 (1984) 424–436
Lindsay KW, M Vermeulen, G Murray: Antifibrinolytic therapy in subarachnoid hemorrhage: Reduction of rebleeding without benefit to outcome. Handbook of the American Association of Neurological Surgeon Annual Meeting 5 (1984) 9
Maurice-Williams RS: Ruptured intracranial aneurysm: Has the incidence of rebleeding been overestimated? J Neurol Neurosurg Psychiatr 45 (1982) 774–779
Menon D, B Weir, T Overton: Ventricular size and cerebral blood flow following subarachnoid hemorrhage. J Comput Assist Tomogr 5 (1981) 328–333
Milhorat TH: Acute hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery 1 (1987) 15–20
Mohr JP, CS Kase: Cerebral vasospasms. Rev Neurol Paris 139 (1983) 99–113
Mohr JP, JP Kistler, JM Zabramski, RF Spetzler, JM Barnett: Intracranial aneurysms. In: Barnett HJM, JP Mohr, BM Stein, FM Yaatsu (eds) Stroke: Pathophysiology diagnosis and management Churchill Livingstone, New York, Edinburgh, London, Melbourne (1986) 643–667
Mohsen F, S Pomonis, R Illingworth: Prediction of delayed cerebral ischemia after subarachnoid hemorrhage by computed tomography. J Neurol Neurosurg Psychiatr 47 (1984) 1197–1202
Pasqualin A, L Rosta, R Da Pian, R Cavazzani: Role of computertomography in the management of vasospasm after subarachnoid hemorrhage. Neurosurgery 15 (1984) 344–353
Philips LH, J Whisnant, WM O'Fallon, T Sundt: The unchanging pattern of subarachnoid hemorrhage in a community. Neurology (NY) 30 (1980) 1034–1040
Redfern RM, S Zygmunt, JD Pickard, PM Foy, MD Shaw: The natural history of subarachnoid haemorrhage with negative angiography: a prospective study and 3-year follow-up. Br J Neurosurg 2 (1988) 33–41
Reynolds AF, CM Shaw: Bleeding patterns from ruptured intracranial aneurysms: An autopsy series of 205 patients. Surg Neurol 15 (1981) 232–235
Sacco RL, PA Wolf, NE Bharucha, SL Meeks, WB Kannel, LJ Charette, PM McNamara, EP Palmer, R D'Agostino: Subarachnoid and intracerebral hemorrhage: Natural history, prognosis and precursive factors in the Framingham Study. Neurology (NY) 34 (1984) 847–854
Sano H, T Kanno, Y Shinomiya, K Katada, Y Katoh, K Adachi: Prospection of chronic vasospasm by CT findings. Acta Neurochir 63 (1982) 23–30
Säveland H, B Sonesson, B Ljunggren, L Brandt, T Uski, S Zygmunt, B Hindfelt: Outcome evaluation following subarachnoid hemorrhage. J Neurosurgery 64 (1986) 191–196
Sundt RM, JP Whisnant: Subarachnoid hemorrhage from intracranial aneurysms. N Engl J Med 299 (1978) 916–928
Suzuki S, T Kayama, Y Sakurai, A Ogawa J Suzuki: Subarachnoid hemorrhage of unknown cause. Neurosurgery 21 (1987) 310–313
Symon L: Hydrocephalus following subarachnoid hemorrhage. In: Pia HW (ed) Cerebral Aneurysms. Advances in diagnosis and therapy. Springer-Verlag, New York 1979
Tomlinson BE: Brain changes in ruptured intracranial aneurysm. J Clin Pathol 12 (1959) 391–399
Torner JC, NF Kassell, RB Wallace, HP Adams: Preoperative prognostic factors from rebleeding and survival in aneurysm patients receiving antifibrinolytic treatment: Report of the Cooperative Aneurysm Study. Neurosurgery 9 (1981) 506–513
Vassilouthis J, AE Richardson: Ventricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg 51 (1979) 341–351
Vermeulen M, KW Lindsay, GH Murray, F Gheah, A Hijdra, JP Muizelaar, M Schannong, GM Teasdale, H van Crevel, J van Gijn: Antifibrinolytic treatment in subarachnoid hemorrhage. N Engl J Med 311 (1984) 432–437
Vermeulen M, J van Gijn: The diagnosis of subarachnoid haemorrhage. J Neurosurg, Psychiatr 51 (1990) 365–372
Wijdicks EFM, M Vermeulen, JA Ten Haaf, A Hijdra, WH Bakker, J van Gijn: Volume depletion and natriuresis in patients with ruptured intracranial aneurysm. A revival of the concept of cerebral salt wasting. Ann Neurol 18 (1985) 211–216
Wijdicks EF, H Kerkhoff, J van Gijn: Long-term follow-up of 71 patients with thunderclap headache mimicking subarachnoid haemorrhage. Lancet 2 (1988) 68–70
Wise BL: Inappropriate secretion of ADH caused by obstruction of ventriculoatrial shunts. J Neurosurg 28 (1968) 429–433
Wozniak M, DG McLone, AJ Raimonde: Micro-and macrovascular changes as the direct cause of parenchymal destruction in congenital massive hydrocephalus. J Neurosurg 43 (1975) 535–542
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Schütz, H., Krack, P., Buchinger, B. et al. Outcome of patients with aneurysmal and presumed aneurysmal bleeding. A hospital study based on 100 consecutive cases in a neurological clinic. Neurosurg. Rev. 16, 15–25 (1993). https://doi.org/10.1007/BF00308606
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00308606