PROGRESS IN THE MANAGEMENT OF PATIENTS WITH ANEURYSMAL SUBARACHNOID HEMORRHAGE - A SINGLE HOSPITAL REVIEW FOR 20 YEARS .2. AGED PATIENTS

BACKGROUND We have reported improvement in the outcome of the younger patients with aneurysmal subarachnoid hemorrhage in the preceding arti cle, The purpose of this article is to study if the same management pr otocol has simultaneously benefited the elderly patients. METHODS One hundred twenty-nine patients with aneurysmal subarachnoid hemorrhage, over 70 years old, who were consecutively admitted to Kagawa Prefectur al Central Hospital from July 1972 to December 1992, were reviewed, Pa tient grouping and outcome evaluation were the same as those of younge r patients. RESULTS Changes in treatment protocol in this period, whic h were similar to those of the younger counterparts, resulted in an in creased number of patients who actually underwent aneurysm clipping. A lthough the outcome evaluated at 6 months after the initial hemorrhage was significantly poorer than that of the younger counterparts, there have been some improvements during the study period. Patients in good clinical condition at 6 months' follow-up (Glasgow Outcome Scale: Goo d Recovery) increased from 37.5% to 42.9% in grades I-II and from 0% t o 23.1% in grade III, respectively. CONCLUSIONS The improvement in the outcome of elderly patients was less remarkable than that observed in younger patients, Significantly higher incidence of preoperative rebl eeding and postoperative symptomatic vasospasm has proven to be the ma jor cause of mortality and major morbidity at present, More careful an d sophisticated perioperative care is required in elderly patients wit h aneurysmal subarachnoid hemorrhage.