title: Subarachnoid hemorrhage and intracerebral hematoma: incidence, prognostic factors, and outcome.
abstract: OBJECTIVE
  To analyze the incidence and impact of an intracerebral hematoma (ICH) on treatment and outcome in patients with aneurysmal subarachnoid hemorrhage.
  
  
  METHODS
  Data of 585 consecutive patients with subarachnoid hemorrhage from June 1999 to December 2005 were prospectively entered in a database. ICH was diagnosed and size was measured by computed tomographic scan before aneurysm occlusion. Fifty patients (8.5%) presented with an ICH larger than 50 cm3. The treatment decision (coil, clip, or hematoma evacuation) was based on an interdisciplinary approach. Patients were stratified into good (Hunt and Hess Grades I-III) versus poor (Hunt and Hess Grades IV and V) grade, and outcome was assessed according to the modified Rankin Scale at 6 months.
  
  
  RESULTS
  Overall, 358 patients presented in good grade, with 4 of them having ICH (1.1%); and 227 patients presented in poor grade, with 46 of them having ICH (20.3%, P < 0.01). In good-grade patients with an ICH (n = 4), a favorable outcome (modified Rankin Scale score of 0-2) was achieved in 1 patient (25%), and in 246 patients (75%) without an ICH (P = 0.053; odds ratio, 0.11). A favorable outcome was achieved in 5 poor-grade patients (12.8%) with an ICH and in 40 patients (23.7%) without an ICH (P = 0.19; odds ratio, 0.47). Time to treatment was significantly shorter in patients with an ICH than without an ICH (median, 7 versus 26 h; P < 0.001) and shortest in patients with favorable outcome (3.5 hours; P < 0.01).
  
  
  CONCLUSIONS
  The current data confirm that the presence of an ICH is a predictor of unfavorable outcome. However, despite large ICHs, a significant number of patients have a good outcome. To achieve a favorable outcome, ultra-early treatment with hematoma evacuation and aneurysm obliteration seems to be mandatory.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany. Gueresir@em.uni-frankfurt.de
authors.forename: Erdem
authors.initials: E
authors.lastname: Güresir
authors.forename: Jürgen
authors.initials: J
authors.lastname: Beck
authors.forename: Hartmut
authors.initials: H
authors.lastname: Vatter
authors.forename: Matthias
authors.initials: M
authors.lastname: Setzer
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Gerlach
authors.forename: Volker
authors.initials: V
authors.lastname: Seifert
authors.forename: Andreas
authors.initials: A
authors.lastname: Raabe
mesh_terms: D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006407:Hematoma, Epidural, Cranial / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate