Life expectancy after perimesencephalic subarachnoid hemorrhage.
OBJECTIVE
Patients with a perimesencephalic nonaneurysmal subarachnoid hemorrhage are not at risk for rebleeding in the initial years after the hemorrhage. Nevertheless, uncertainty remains on the long-term prognosis after perimesencephalic hemorrhage, and former patients are often considered high-risk cases for health insurance or are denied life insurance. We performed a very long-term follow-up study of a large consecutive series of such patients and compared mortality in this cohort with that in the general population.


METHODS
All patients with a perimesencephalic hemorrhage (defined by pattern of hemorrhage on computed tomography within 72 hours after onset and absence of aneurysm) admitted between 1983 and 2005 to our service were followed-up by telephone. For patients who had died, we retrieved age and cause of death. We compared the age- and sex-specific mortality of this cohort with that of the general population by means of standardized mortality ratios with corresponding 95% confidence intervals.


RESULTS
The cohort consisted of 160 patients, with a total number of patient-years of 1213. No new episodes of subarachnoid hemorrhage had occurred. During follow-up 11 patients had died; the expected number of deaths based on mortality rates in the general population (adjusted for age and gender) was 18.1. The standardized mortality ratio was 0.61 (95% confidence interval, 0.34 to 1.1).


CONCLUSIONS
Patients with perimesencephalic hemorrhage have a normal life expectancy and are not at risk for rebleeding. No restrictions should be imposed on these patients by physicians or health or life insurance companies.
Greebe
Paut
P
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands.
Rinkel
Gabriël J E
GJ
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007348:Insurance, Health / Q000592:standards; D007407:Interviews as Topic; D008017:Life Expectancy / Q000639:trends*; D008297:Male; D008636:Mesencephalon / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D017678:Sex Distribution; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology*