Aneurysmal Subarachnoid Hemorrhage

Abstract

Subarachnoid hemorrhage (SAH) is a common and devastating condition. Each year approximately 30,000 Americans suffer from a nontraumatic SAH. Patients who have suffered an SAH are best managed in an ICU or a specialized neurology/neurosurgical unit. Despite improved management, the outcome following SAH remains poor; with an overall mortality of approximately 25% and significant morbidity among the survivors. The most serious complications following the initial bleed are rebleeding and cerebral vasospasm; management of patients with SAH is therefore largely directed to avoiding these complications. The risk of rebleeding (with conservative therapy) is highest in the first month, with a rate of between 20% and 30%. The mortality rate is approximately 70% for patients who rebleed. Angiographic vasospasm probably develops to some degree in most patients who suffer a SAH. However, clinically manifest vasospasm occurs in approximately 40% of patients. From 15% to 20% of these patients will suffer a stroke or die despite aggressive management.