Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 Mar;68(3):337–341. doi: 10.1136/jnnp.68.3.337

Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in The Netherlands

Y Roos 1, R J de Haan 1, L Beenen 1, R Groen 1, K Albrecht 1, M Vermeulen 1
PMCID: PMC1736841  PMID: 10675216

Abstract

OBJECTIVE—The aim of this study was to investigate prospectively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these patients have "modern treatment"—that is, early obliteration of the aneurysm and treatment with calcium antagonists—what factors cause a delay in surgical or endovascular treatment, and what the estimated effect on outcome will be of improved treatment.
METHODS—A prospective, observational cohort study of all patients with aneurysmal subarachnoid haemorrhage in the hospitals of a specified region in The Netherlands. The condition on admission, diagnostic procedures, and treatments were recorded. If a patient had a clinical deterioration, the change in Glasgow coma score (GCS), the presence of focal neurological signs, the results of additional investigations, and the final diagnosed cause of the deterioration were recorded.
 Clinical outcome was assessed with the Glasgow outcome scale (GOS) at 3 month follow up. In patients with poor outcome at follow up, the cause was diagnosed.
RESULTS—Of the 110 patients, 47 (43%) had a poor outcome. Cerebral ischaemia, 31 patients (28%), was the most often occurring complication. Major causes of poor outcome were the effects of the initial haemorrhage and rebleeding in 34% and 30% of the patients with poor outcome respectively. Of all patients 102 (93%) were treated with calcium antagonists and 45 (41%) patients had early treatment to obliterate the aneurysm. The major causes of delay of treatment were a poor condition on admission or deterioration shortly after admission, in 31% and 23% respectively.
CONCLUSIONS—In two thirds of the patients with poor outcome the causes of poor outcome are the effects of the initial bleeding and rebleeding. Improved treatment of delayed or postoperative ischaemia will have only minor effects on the outcome of patients with subarachnoid haemorrhage.



Full Text

The Full Text of this article is available as a PDF (89.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Broderick J. P., Brott T. G., Duldner J. E., Tomsick T., Leach A. Initial and recurrent bleeding are the major causes of death following subarachnoid hemorrhage. Stroke. 1994 Jul;25(7):1342–1347. doi: 10.1161/01.str.25.7.1342. [DOI] [PubMed] [Google Scholar]
  2. Feigin V. L., Rinkel G. J., Algra A., Vermeulen M., van Gijn J. Calcium antagonists in patients with aneurysmal subarachnoid hemorrhage: a systematic review. Neurology. 1998 Apr;50(4):876–883. doi: 10.1212/wnl.50.4.876. [DOI] [PubMed] [Google Scholar]
  3. Hasan D., Vermeulen M., Wijdicks E. F., Hijdra A., van Gijn J. Effect of fluid intake and antihypertensive treatment on cerebral ischemia after subarachnoid hemorrhage. Stroke. 1989 Nov;20(11):1511–1515. doi: 10.1161/01.str.20.11.1511. [DOI] [PubMed] [Google Scholar]
  4. Jennett B., Bond M. Assessment of outcome after severe brain damage. Lancet. 1975 Mar 1;1(7905):480–484. doi: 10.1016/s0140-6736(75)92830-5. [DOI] [PubMed] [Google Scholar]
  5. Longstreth W. T., Jr, Nelson L. M., Koepsell T. D., van Belle G. Clinical course of spontaneous subarachnoid hemorrhage: a population-based study in King County, Washington. Neurology. 1993 Apr;43(4):712–718. doi: 10.1212/wnl.43.4.712. [DOI] [PubMed] [Google Scholar]
  6. Mayberg M. R., Batjer H. H., Dacey R., Diringer M., Haley E. C., Heros R. C., Sternau L. L., Torner J., Adams H. P., Jr, Feinberg W. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke. 1994 Nov;25(11):2315–2328. doi: 10.1161/01.str.25.11.2315. [DOI] [PubMed] [Google Scholar]
  7. Pickard J. D., Murray G. D., Illingworth R., Shaw M. D., Teasdale G. M., Foy P. M., Humphrey P. R., Lang D. A., Nelson R., Richards P. Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British aneurysm nimodipine trial. BMJ. 1989 Mar 11;298(6674):636–642. doi: 10.1136/bmj.298.6674.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Rinkel G. J., Wijdicks E. F., Hasan D., Kienstra G. E., Franke C. L., Hageman L. M., Vermeulen M., van Gijn J. Outcome in patients with subarachnoid haemorrhage and negative angiography according to pattern of haemorrhage on computed tomography. Lancet. 1991 Oct 19;338(8773):964–968. doi: 10.1016/0140-6736(91)91836-j. [DOI] [PubMed] [Google Scholar]
  9. Roos Y. B., Beenen L. F., Groen R. J., Albrecht K. W., Vermeulen M. Timing of surgery in patients with aneurysmal subarachnoid haemorrhage: rebleeding is still the major cause of poor outcome in neurosurgical units that aim at early surgery. J Neurol Neurosurg Psychiatry. 1997 Oct;63(4):490–493. doi: 10.1136/jnnp.63.4.490. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Teasdale G. M., Drake C. G., Hunt W., Kassell N., Sano K., Pertuiset B., De Villiers J. C. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry. 1988 Nov;51(11):1457–1457. doi: 10.1136/jnnp.51.11.1457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Teasdale G., Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974 Jul 13;2(7872):81–84. doi: 10.1016/s0140-6736(74)91639-0. [DOI] [PubMed] [Google Scholar]
  12. Vermeulen M., Hasan D., Blijenberg B. G., Hijdra A., van Gijn J. Xanthochromia after subarachnoid haemorrhage needs no revisitation. J Neurol Neurosurg Psychiatry. 1989 Jul;52(7):826–828. doi: 10.1136/jnnp.52.7.826. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Vermeulen M., van Gijn J. The diagnosis of subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 1990 May;53(5):365–372. doi: 10.1136/jnnp.53.5.365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Whitfield P. C., Moss H., O'Hare D., Smielewski P., Pickard J. D., Kirkpatrick P. J. An audit of aneurysmal subarachnoid haemorrhage: earlier resuscitation and surgery reduces inpatient stay and deaths from rebleeding. J Neurol Neurosurg Psychiatry. 1996 Mar;60(3):301–306. doi: 10.1136/jnnp.60.3.301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. van Gijn J., Bromberg J. E., Lindsay K. W., Hasan D., Vermeulen M. Definition of initial grading, specific events, and overall outcome in patients with aneurysmal subarachnoid hemorrhage. A survey. Stroke. 1994 Aug;25(8):1623–1627. doi: 10.1161/01.str.25.8.1623. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES