WARNING LEAK AND MANAGEMENT OUTCOME IN ANEURYSMAL SUBARACHNOID HEMORRHAGE

The impact of warning leaks on management results in patients with ane urysmal subarachnoid hemorrhage (SAH) was evaluated in this prospectiv e study. In a consecutive series of 422 patients with aneurysmal SAH, 84 patients (19.9%) had an episode suggesting a warning leak; 34 (40.5 %) of these patients were seen by a physician without the condition be ing recognized. The warning leak occurred less than 2 weeks before a m ajor SAH in 75% of the patients. A good outcome was experienced by 53. 6% of patients who had a warning leak versus 63.3% of those who had no warning leak. In a subgroup of patients who had an interval of 3 days or less from warning leak to SAH, only 36.4% had a good outcome. The proportion of patients in good neurological condition (Hunt and Hess G rades I and II) who had a good outcome was 88.1% in the group with no warning leak versus 53.6% in the group whose SAH was preceded by a war ning leak. A difference of 35% between these two groups reflects the i mpact of an undiagnosed warning leak on patient outcome, based on the assumption that patients with a warning leak had clinical conditions n o worse than Hunt and Hess Grade II at the time of the episode. In the subgroup of patients with the short interval between warning leak and SAH, the difference was almost 52%. The difference in outcome also re flects the potential improvement in outcome that can be achieved by a correct diagnosis of the warning leak. If the correct diagnosis is mad e in patients seeking medical attention due to a warning leak, favorab le outcomes in the overall management of aneurysmal SAH are estimated to increase by 2.8%. An active diagnostic attitude toward patients exp eriencing a sudden and severe headache is warranted as it offers a mea ns of improving overall outcome in patients with SAH.