[Therapy and prognosis of subarachnoid hemorrhage due to rupture of a cerebral aneurysm]

Abstract

The morbidity and mortality in 100 consecutive patients, almost all admitted within one week after a proven subarachnoid hemorrhage, were investigated in a prospective study. An aneurysm was demonstrated by angiography or autopsy in 76 patients, while in 24 patients the cerebral panangiography was normal. 13.1% of the patients with a proven aneurysm died within 48 hours of the hemorrhage as a consequence of a massive initial bleeding, 23.6% died from preoperative rebleeding or brain infarcts due to cerebral vascular spasms, 2.6% from direct operative complications and 2.6% from brain infarcts due to postoperative cerebral vascular spasms. The total case mortality was 41.9%. This high mortality was due to massive initial hemorrhage, early rebleedings and in particular to pre- and postoperative brain infarcts due to cerebral vascular spasms. The prognosis can only be improved significantly by early diagnosis and admission and effective prophylaxis and therapy of the vasospasm, but not by further perfecting of surgical technique.