Aneurysmal Subarachnoid Hemorrhage; 4 years study at Lahore General Hospital

Abstract

This study was conducted in unit I, during the last 4 years. Total admissions of patients with subarachnoid hemorrhage have been 267. Clinical presentation of 267 patients with subarachnoid hemorrhage (SAH) was classical. There was history of attack during stressful conditions or during sleep, after day’s stress. Headache, vomiting, neck stiffness was present in 240 (90%) patients. Hypertension was known in 133(50%) patients. During 2004 there were 88 patients, while in 2001 there were 42 admissions with the condition. Maximum number of cases, 29(58%) belonged to 40-60 years of age. There was slight female preponderance. The patients were evaluated according to WFNS grading system. Majority 128(80%) belonged to poor Grade III on admission. Some 69(26%) patients, died before angiography, while 37(14%) died after angiography, before surgery. Anterior Cerebral Artery aneurysms, were the commonest 91(57%) aneurysms. Total surgeries done were in 160 patients. Delayed surgery with optimal delay of 6-14 days was done in majority of cases. Surgical approaches were Pterional, Sub frontal and Frontolateral approaches. Intracranial complications of 267 patients, were rebleed in 5 3(20%) patients, vasospasm in 27 patients (10%), hydrocephalus in 27(10%) patients. Extracranial complications included, myocardial infarction in 11(4%), cardiac arrhythmias in 21(8%), pulmonary edema in 16(6%) and stress ulcers in 37(14%) patients. Peroperative complications included, aneurysm rupture in 30% and aneurysm avulsion in 1 case. Operative mortality was 13% (21 patients). In 267 SAH cases, management mortality has been 48%( 79 patients). Outcome of 160 operated cases was encouraging as good recovery (employment) in 80 (50%) patients: The incidence/Diagnosis of aneurysmal SAH, is increasing in our setup. Aneurysmal SAH also occurs in younger age group. Prognostic factors include early presentation and good WFNS grade on admission