Clinical Analysis of Spontaneous Subarachnoid Hemorrhagic Patients

Oh, Yeun Wook; Yoon, Young Soo; Park, Moon Sun; Lee, Yeung Keun

Abstract

From the young neurosurgeon's standpoint, the authors analyzed eighty patients of spontaneous subarachnoid hemorrhage who were admitted to the department of neurosurgery in Taejeon Eulji General hospital from May 1989 to Jan. 1992. The results of analysis were as follow: 1) Of 80 total cases, sixty six were managed from beginning to end, and forty two were operated on for neck clipping. The most common cause of SAH was aneurismal rupture(70%), and the idiopathic comprised 30%. The male versus female ratio was 1:1.7, and the most frequently involved decade was the 7th. 2) Fifty six of total aneurismal cases turned out to be ruptured prior to admission. Common locations of aneurysms were A-com., P-com., and M.C.A. in order of descending frequency. Mirror aneurysms were 4%, and the multiple, 21%. The smallest size of aneurysm that had already ruptured was 3mm in its largest diameter of sac. The giant cases were 2(4%). 3) The most common chief complaint was headache(62.5%), and the most common symptom and/or sign was vomiting(90%). The hypertension accompanied in 29% and the most common neurological sign was nuchal rigidity(71%). 4) The brain CT was performed with the frequency of 1.44 per patient, and it detected SAH in 86%, The most frequently obliterated cistern was basal cistern. In 11 cases(14%), there were no evidence of SAH at all. Contrastingly in 12 cases(15%), aneurismal sacs were directly visualized in post-contrast films. 5) The angiographic study was performed in 59 cases(74%) to detect abnormality in 54 cases all of which turned out to be aneurysms. The mean size of detected 69 sacs was 7.7mm in diameter, and of 26 cases(44%) of normal variation, hypoplasia was the most frequent type. It occurred most frequently at right A1 portion. 6) Of 66 patients who were managed from start to finish, the mortality was 43%, and that of 46 operated cases, 21%. The best operative results were harvested in delayed operation group, the next in intermediate one, and the worst in early one.