WHICH ARE THE MAJOR DETERMINANTS FOR OUTCOME IN ANEURYSMAL SUBARACHNOID HEMORRHAGE - A PROSPECTIVE TOTAL MANAGEMENT STUDY FROM A STRICTLY UNSELECTED SERIES

In this prospective study we report the outcome for all patients with a verified aneurysmal SAH managed at the Department of Neurosurgery at the University Hospital in Lund, Sweden during the four-year span fro m June 1, 1989 to May 31, 1993. A total of 275 patients were admitted during the study period. The vast majority of patients (196 individual s, i.e. 71%) was admitted within 24 h after the bleed. Mean age was 54 .3 years and the female/male ratio 1.8/1. Nimodipine was administered in 231 (84%) of the 275 patients. We clipped the ruptured aneurysm in 199 patients. At follow-up 3 months after the bleed 161 patients were classified as having made a good neurological recovery (59%). The morb idity was 20% and 59 patients (21%) had died. The overwhelming cause f or morbidity and mortality was damage from the initial bleed (62 patie nts, 23%). Notably, considering morbidity and mortality, delayed ische mia was less frequent than both surgical complications and rebleeding, respectively. Of the 275 patients, 13 (5%) patients made an unfavorab le outcome due to delayed ischemic deterioration. There was a strict c orrelation between the initial clinical condition and final outcome. O f 51 grade V patients, only 2 made a good recovery. There was also a s trict correlation between the amount of extravasated blood and outcome . There was no difference in clinical outcome between patients with ar terial hypertension versus normotensive individuals. The mortality rat e was worse for posterior circulation aneurysms. In conclusion, releva nt prognostic factors after an aneurysmal SAH are the amount of subara chnoid blood as shown by CT, clinical grade upon admission, age and lo cation of the ruptured aneurysm but not gender and pre-existing arteri al hypertension.