Estudio de 234 pacientes con hemorragia subaracnoidea de origen aneurismatico y criptogenético

Abstract

Subarachnoidal hemorrhage (SAH) is a medical emergency in all the patients. There are some known risk factors and, some complications associated to subarachnoid hemorrhage due to aneurysm rupture, being the rebleeding the main cause of mortality. We performed a retrospective study of 234 patients with non traumatic SAH treated in the Hospital Clínic i Provincial of Barcelona from January 1993 to December 1999. Diagnosis of SAH was done by CT, and ethiological diagnosis by brain angiography. We pay attention to previous pathological history, Hunt-Hess, WFNS and Fisher scales, and we divided our population in two groups depending on the treatment (surgery or embolization). We analyzed SAH complications and GOS at discharge and in a year. Population main age was 53.67 years-old (16-88 years-old). The relationship between male:female was 1:1.4. Almost out of 37% of the patients had previous history of high blood pressure, out of 25.9% were smokers. We saw a bleeding predominance within active hours (from 8:00 to 22:00), mostly during the morning (from 8:00 to 14:00). Between the complications associated to SAH, 45 patients (out of 19.2%) suffered clinical vasospasm, 24 patients (out of 10.25%) rebleeded, 61 patients (out of 26%) had some degree of hydrocephallus post-SAH, and 38 patients (out of 16.23%) had seizures. In 31 cases the bleeding pattern in CT scan was non-perimesencephalic (out of 62% of the 50 patients with negative angiography) and, in 19 cases (out of 38%) was perimesencephalic one. Patients with angiography had 150 aneurysms from anterior circulation and, 12 from posterior circulation. We performed surgery in ninety eight patients, and embolization in 38. We found among embolized patients a worse clinical status and massive hemorrhages than in surgery ones, and, those patients had higher mortality rates and severe sequelae. We noticed that sex, pathological history and bleeding timing rates similar than previously published, either than SAH complications. We deeply analyzed those patients with negative angiography and their bleeding pattern, finding that a perimesencephalic bleeding pattern could be caused by an aneurysm, as nowadays publications point out. Due to the above reason we tried to perform a second angiography to every patient with a negative first one. We want to highlight among treated patients, those embolized had a most severe clinical status and then their prognosis and mortality rate was higher. Finally, surgical group, had a high rate of ischemic complications, and most part of this patients group didn't get a control angiography, thus lead us to change our policy, seeing the final results. This study has been specially self-helpful in order to analyze our medical policy in front of this entity, and in this way, to elaborate a protocol of treatment taking account nowadays tendencies and our experience.