Long-Term Prognosis

Abstract

The number of patients in the population who survived an episode of subarachnoid hemorrhage is increasing because the incidence of subarachnoid hemorrhage has remained stable and the case fatality has decreased significantly over the last decades. The number of expected life years for former patients is considerable because the mean age at which subarachnoid hemorrhage occurs is only 55 years of age. Since aneurysms develop during life and hypertension and smoking are important risk factors for subarachnoid hemorrhage, former patients are at risk of new aneurysms, new episodes of subarachnoid hemorrhage and increased risk of other cardiovascular diseases. The risk of a new episode of subarachnoid hemorrhage in survivors is 15 times higher than in the general population. The absolute risk is however only 3 % in the initial 10 years, and screening for new aneurysms is in general not efficient but should be discussed with patients with familial subarachnoid hemorrhage and in patients who had a first hemorrhage at young age (i.e. under 35–40 years of age). Persons who have survived an episode of subarachnoid hemorrhage have in the initial two decades after the hemorrhage a 1.5–2 times greater risk of death than the general population; in absolute terms, the risk of death is around 40 % after these initial two decades. The majority of causes of death are cardiovascular. Recovery of physical and cognitive deficits continues over the initial years after the hemorrhage, and beyond these initial years of recovery, quality of life continues to improve despite no further improvement in handicap. To reduce the risk of cardiovascular events, all patients should refrain from smoking and should have blood pressure properly checked and treated in case of hypertension.