Jp. Broderick et al., INITIAL AND RECURRENT BLEEDING ARE THE MAJOR CAUSES OF DEATH FOLLOWING SUBARACHNOID HEMORRHAGE, Stroke, 25(7), 1994, pp. 1342-1347
Background and Purpose The goal of this study was to determine the cau
ses of mortality and morbidity after subarachnoid hemorrhage. Methods
We identified all first-ever spontaneous subarachnoid hemorrhages that
occurred in the nearly 1.3 million population of greater Cincinnati d
uring 1988. Results Thirty-day mortality for subarachnoid hemorrhage w
as 45% (36 of 80 cases). Of the 36 deaths, 22 (61%) died within 2 days
of onset; 21 of these deaths were due to the initial hemorrhage, and
one death was due to rebleeding documented by computed tomography. Nin
e of the remaining 14 deaths after day 2 were caused by the initial he
morrhage (2 cases) or rebleeding (7 cases). Volume of subarachnoid hem
orrhage was a powerful predictor of 30-day mortality (P=.0001). Only 3
of the 29 patients with a volume of subarachnoid hemorrhage of 15 cm(
3) or less died before 30 days. Two of these 3 patients died from docu
mented rebleeding; the third had 87 cm(3) of additional intraventricul
ar hemorrhage. Delayed arterial vasospasm contributed to only 2 of all
36 deaths. Conclusions Most deaths after subarachnoid hemorrhage occu
r very rapidly and are due to the initial hemorrhage. Rebleeding is th
e most important preventable cause of death in hospitalized patients.
In a large representative metropolitan population, delayed arterial va
sospasm plays a very minor role in mortality caused by subarachnoid he
morrhage.