gms | German Medical Science

Objective: Rupture of intracranial aneurysms lead to subarachnoid hemorrhage (SAH). Patients presenting with combination of SAH and acute subdural hematoma (aSDH) have commonly been reported to be of poor admission grade and having an unfavourable outcome. We therefore performed an analysis of our neurovascular database to analyze factors determining outcome in these critically ill patients.

Method: Between June 1999 and June 2011, data of 989 consecutive patients with aneurysm related SAH were prospectively entered in a database. 18 patients (1.8%) with aneurysm related SAH and aSDH were treated at our institution. The treatment decision (clip, coil) was based on an interdisciplinary approach. Patient characteristics, time to treatment, clinical condition on admission, location and size of aneurysm, and functional outcome were analyzed. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months. MEDLINE was searched for published studies of aneurysm related SAH and aSDH to gain a larger population. A multivariate regression analysis was performed on the pooled data.

Results: Literature data, including the present series revealed a total of 111 patients. Overall, 38 of 111 patients (34%) with aneurysm related SAH and aSDH achieved favourable outcome (mRS 0-2). 68% of the patients with good grade clinical condition on admission vs. 23% of the patients with poor grade clinical presentation achieved favourable outcome (p<0.0001). In the multivariate analysis poor clinical condition on admission was the only predictor for unfavourable outcome (p=0.02).

Conclusions: The current data confirm that initial clinical status and neurological grade at admission is associated with functional outcome. Therefore, despite poor clinical condition at admission treatment should not be omitted because a considerable number of patients with aneurysm related SAH and aSDH might achieve favourable outcome.