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Clinical Profile and Outcome in Patients with Spontaneous Subarachnoid Hemorrhage from a South Indian Tertiary Centre: A Prospective Observational Study
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.
Keywordsaneurysmal rupture - intracranial aneurysms - mortality predictors - neurological outcome - spontaneous SAH - subarachnoid hemorrhage
Anuusha Subathra Sadasivam contributed to investigation, project administration, writing original draft, and analysis. Balamurugan Nathan contributed to conceptualization, writing, review, and editing, and supervision of the study. Sathia Prabhu Anbazhagan contributed to conceptualization, and writing, review, and editing.
Institutional Review Board Approval
The study was approved by the Institute Research Council and Institute Human Ethics Committee (Project No. JIP/IEC/2019/416 dated February 4, 2020).
Article published online:
27 March 2023
© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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- 1 Ohkuma H, Tabata H, Suzuki S, Islam MS. Risk factors for aneurysmal subarachnoid hemorrhage in Aomori, Japan. Stroke 2003; 34 (01) 96-100
- 2 Ramnarayan R, Anto D, Alapatt J. Aneurysmal subarachnoid hemorrhage: geography has a role. Asian J Neurosurg 2018; 13 (03) 669-673
- 3 Shingare A, Nadkar MY, Singh R. Study of patient characteristics/profile and factors determining the (immediate) outcome in spontaneous subarachnoid hemorrhage. J Assoc Physicians India 2011; 59: 505-508
- 4 Bhat AR, Afzalwani M, Kirmani AR. Subarachnoid hemorrhage in Kashmir: Causes, risk factors, and outcome. Asian J Neurosurg 2011; 6 (02) 57-71
- 5 Koshy L, Easwer HV, Premkumar S. et al. Risk factors for aneurysmal subarachnoid hemorrhage in an Indian population. Cerebrovasc Dis 2010; 29 (03) 268-274
- 6 Dabilgou AA, Drave A, Kyelem JMA, Naon L, Napon C, Kabore J. Spontaneous subarachnoid haemorrhage in neurological setting in Burkina Faso: clinical profile, causes, and mortality risk factors. Neurol Res Int 2019; 2019: 8492376
- 7 Chaturbedi A, Hossain AM, Hossain SS, Rahman Z, Barua KK. Clinical profile, risk factors and outcome assessment of aneurysmal subarachnoid hemorrhage (SAH) patients: a multicenter study in Bangladesh. Int J Neurosurg. 2019; 2 (02) 43
- 8 Kowalski RG, Claassen J, Kreiter KT. et al. Initial misdiagnosis and outcome after subarachnoid hemorrhage. JAMA 2004; 291 (07) 866-869
- 9 Macdonald RL, Schweizer TA. Spontaneous subarachnoid haemorrhage. Lancet 2017; 389 (10069): 655-666
- 10 Qureshi AI, Suri MF, Sung GY. et al. Prognostic significance of hypernatremia and hyponatremia among patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2002; 50 (04) 749-755 , discussion 755–756
- 11 Kim JH, Jeon J, Kim J. Lower risk of subarachnoid haemorrhage in diabetes: a nationwide population-based cohort study. Stroke Vasc Neurol 2021; 6 (03) 402-409
- 12 India State-Level Disease Burden Initiative Diabetes Collaborators. The increasing burden of diabetes and variations among the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health 2018; 6 (12) e1352-e1362
- 13 Pradeepa R, Mohan V. Epidemiology of type 2 diabetes in India. Indian J Ophthalmol 2021; 69 (11) 2932-2938
- 14 Feigin VL, Rinkel GJ, Lawes CM. et al. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke 2005; 36 (12) 2773-2780
- 15 Polmear A. Sentinel headaches in aneurysmal subarachnoid haemorrhage: what is the true incidence? A systematic review. Cephalalgia 2003; 23 (10) 935-941
- 16 Suwatcharangkoon S, Meyers E, Falo C. et al. Loss of consciousness at onset of subarachnoid hemorrhage as an important marker of early brain injury. JAMA Neurol 2016; 73 (01) 28-35
- 17 Lanzino G, D'Urso PI, Suarez J. Participants in the International Multi-Disciplinary Consensus Conference on the Critical Care Management of Subarachnoid Hemorrhage. Seizures and anticonvulsants after aneurysmal subarachnoid hemorrhage. Neurocrit Care 2011; 15 (02) 247-256
- 18 D'Souza S. Aneurysmal subarachnoid hemorrhage. J Neurosurg Anesthesiol 2015; 27 (03) 222-240
- 19 van Asch CJ, van der Schaaf IC, Rinkel GJ. Acute hydrocephalus and cerebral perfusion after aneurysmal subarachnoid hemorrhage. Am J Neuroradiol 2010; 31 (01) 67-70
- 20 Saramma P, Menon RG, Srivastava A, Sarma PS. Hyponatremia after aneurysmal subarachnoid hemorrhage: implications and outcomes. J Neurosci Rural Pract 2013; 4 (01) 24-28
- 21 van Gijn J, Rinkel GJ. Subarachnoid haemorrhage: diagnosis, causes and management. Brain 2001; 124 (Pt 2): 249-278
- 22 Waweru P, Gatimu SM. Mortality and functional outcomes after a spontaneous subarachnoid haemorrhage: a retrospective multicentre cross-sectional study in Kenya. PLoS One 2019; 14 (06) e0217832
- 23 Dupont S, Rabinstein AA. Extent of acute hydrocephalus after subarachnoid hemorrhage as a risk factor for poor functional outcome. Neurol Res 2013; 35 (02) 107-110
- 24 Luong CQ, Ngo HM, Hoang HB. et al. Clinical characteristics and factors relating to poor outcome in patients with aneurysmal subarachnoid hemorrhage in vietnam: a multicenter prospective cohort study. PLoS One 2021; 16 (08) e0256150
- 25 Galea JP, Dulhanty L, Patel HC. UK and Ireland Subarachnoid Hemorrhage Database Collaborators. Predictors of outcome in aneurysmal subarachnoid hemorrhage patients: observations from a multicenter data set. Stroke 2017; 48 (11) 2958-2963
- 26 Lantigua H, Ortega-Gutierrez S, Schmidt JM. et al. Subarachnoid hemorrhage: who dies, and why?. Crit Care 2015; 19 (01) 309