CAUSES OF MORBIDITY AND MORTALITY FOLLOWING INTRACRANIAL ANEURYSM RUPTURE

Objective: To determine the current recovery rates and causes for morb idity and mortality in patients suffering aneurysmal subarachnoid hemo rrhage (SAH). Methods: We reviewed a recent consecutive series of 95 p atients with ruptured intracranial aneurysms who presented to our hosp ital between 1994 and 1995. When administered, active treatment consis ted of early surgery for aneurysm clipping and aggressive prevention a nd treatment of SAH-related complications. Results: Eighty-eight (93%) of the patients were admitted within 24 hours of rupture. One-quarter of the patients in this series did not undergo aneurysm clippings due to poor neurological condition on presentation. Of the 75 patients in itially considered for active treatment, 83% underwent surgery within 48 hours of rupture, all received nimodipine, 16% received tissue plas minogen activator to lyse subarachnoid or intraventricular clots, 40% underwent hypertensive treatment, and 7% underwent transluminal balloo n angioplasty for vasospasm. At one year followup, 29% of patients had died, 7% had severe disabilities, 13% had moderate disabilities, 51% had made a good recovery, and 64% of all surviving patients had return ed to their previous work status. Primary and contributing causes of d eath and disability, affecting 47 patients at one year, were: direct e ffects of the initial hemorrhage (79% of affected patients), surgical complications (13%), vasospasm (11%), rebleeding (11%) and medical com plications (13%). Conclusions: Almost two-thirds of patients suffering aneurysm rupture make a satisfactory recovery with modem treatment. W hile vasospasm has become a less common cause of poor outcome followin g SAH, surgical complications remain an important problem.