Causes of morbidity and mortality following intracranial aneurysm rupture

Objective: To determine the current recovery rates and causes for morbidity and mortality in patients suffering aneurysmal subarachnoid hemorrhage (SAH). Methods: We reviewed a recent consecutive series of 95 patients with ruptured intracranial aneurysms who presented to our hospital between 1994 and 1995. When administered, active treatment consisted of early surgery for aneurysm clipping and aggressive prevention and treatment of SAH-related complications. Results: Eighty-eight (93%) of the patients were admitted within 24 hours of rupture. One-quarter of the patients in this series did not undergo aneurysm clippings due to poor neurological condition on presentation. Of the 75 patients initially considered for active treatment, 83% underwent surgery within 48 hours of rupture, all received nimodipine, 16% received tissue plasminogen activator to lyse subarachnoid or intraventricular clots, 40% underwent hypertensive treatment, and 7% underwent transluminal balloon angioplasty for vasospasm. At one year followup, 29% of patients had died, 7% had severe disabilities, 13% had moderate disabilities, 51% had made a good recovery, and 64% of all surviving patients had returned to their previous work status. Primary and contributing causes of death and disability, affecting 47 patients at one year, were: direct effects of the initial hemorrhage (79% of affected patients), surgical complications (13%), vasospasm (11%), rebleeding (11%) and medical complications (13%). Conclusions: Almost two-thirds of patients suffering aneurysm rupture make a satisfactory recovery with modem treatment. While vasospasm has become a less common cause of poor outcome following SAH, surgical complications remain an important problem.