Abstract
Objective Spontaneous subarachnoid hemorrhage (SAH) is a neurological condition that causes
significant morbidity and mortality. It is known to have regional differences in its
incidence. Indian studies have shown conflicting results about the incidence of aneurysms
as the cause of SAH, varying from 35% to 80%. The data available on the epidemiology
of spontaneous SAH in the South Indian population are very few. Our study aims to
describe the clinical profile of patients presenting with spontaneous SAH to the emergency
department in a tertiary center in South India and describe the factors influencing
the clinical outcome.
Materials and Methods The study included 75 patients diagnosed with spontaneous SAH in our emergency department.
Demographic data, medical history, details about the first medical contact, clinical
features at admission, complications during the hospital stay, and interventions underwent
were recorded. The study participants were followed-up at 6 weeks after discharge
from hospital to assess the neurological outcome based on modified Rankin Scale (mRS)
score, using a 9-point questionnaire.
Results Of the 75 patients with spontaneous SAH, the majority were females, and in the age
group of 50 to 69 years. The median time to first medical contact was observed to
be 2 hours; and SAH was diagnosed at the first medical contact only in 37% of the
patients. Hypertension was the most common comorbid condition associated with SAH
(53%). Almost 80% of the patients who underwent angiographic studies had aneurysmal
SAH (aSAH). Hydrocephalus was the most common complication seen in 37% of the patients,
followed by hyponatremia (28%) and vasospasm (25%). At the time of follow-up after
6 weeks, we found that 36% of the patients were having a neurologically favorable
outcome with an mRS score of 0 to 2, 8% of patients were having moderate to severe
disability (mRS 3 to 5) and were living a dependent life. The mortality rate (mRS
6) was observed to be around 50% (6% lost to follow-up).
Conclusion We observed a relatively higher incidence of aneurysmal rupture among the patients
with spontaneous SAH in our region. The misdiagnosis rate at first medical contact
was higher. The mortality rate was observed to be around 50% at 6 weeks. Loss of consciousness
at ictus, aneurysmal rupture, WFNS grades IV–V, hydrocephalus, vasospasm, hypernatremia,
and delayed cerebral ischemia were found to be the mortality predictors in SAH.
Keywords aneurysmal rupture - intracranial aneurysms - mortality predictors - neurological
outcome - spontaneous SAH - subarachnoid hemorrhage
