Progress in the management of patients with aneurysmal subarachnoid hemorrhage: a single hospital review for 20 years. Part I: Younger patients.
BACKGROUND
This study was carried out to clarify if there has been any improvement in the outcome of patients with aneurysmal subarachnoid hemorrhage during the past 20 years. Because elderly patients have apparently poorer prognoses than younger patients, patients older than 70 years were analyzed separately in the following article.


METHODS
Five hundred seventy-one patients with aneurysmal subarachnoid hemorrhage, under 70 years, who were consecutively admitted to Kagawa Prefectural Central Hospital from July 1972 to December 1992, were reviewed. These patients were divided into four groups according to the time of admission. The ultimate outcome was evaluated by means of Glasgow Outcome Scale 6 months after the ictus.


RESULTS
Changes in treatment protocol in this period included the induction of early surgery and the invention of a variety of modalities for the treatment of cerebral vasospasm. This resulted in a distinct increase in patients who actually underwent direct aneurysm clipping. Outcome has been significantly improved during this period, especially in patients with Hunt and Kosnik grade III (p<0.05, chi2). Patients in good clinical condition at follow-up (Glasgow Outcome Scale: good recovery) increased from 8.7% to 60.7%. Mortality decreased from 28.7% to 10.7%.


CONCLUSIONS
Current therapeutic modalities have significantly improved the outcome of patients with aneurysmal subarachnoid hemorrhage. Rebleeding before early surgery remains as a major cause of unfavorable outcome and further progress on this subject is mandatory.
Moriyama
E
E
Department of Neurosurgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
Matsumoto
Y
Y
Meguro
T
T
Kawada
S
S
Mandai
S
S
Gohda
Y
Y
Sakurai
M
M
D000368:Aged; D002533:Cerebral Angiography; D005260:Female; D006296:Health Services / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000503:physiopathology; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology