Update on the Management of Subarachnoid Hemorrhage

Katja E Wartenberg


Future Neurology. 2013;8(2):205-224. 

In This Article


The mortality rate was reduced from 50 to 25–35%.[202–204] Mortality rates are higher in women than in men.[205–207] Of the two-thirds of patients who survive, approximately 50% are permanently disabled, mainly due to neurocognitive deficits (20%), anxiety and depression, which occur in up to 80% of patients. Many patients do not return to work or retire early, and their relationships are affected.[208,209] Older age, poor clinical grade upon presentation, rebleeding, larger aneurysm size, global cerebral edema, DCI and medical complications impact on functional outcome after SAH. Of all these factors, the clinical condition upon arrival in the hospital appears to be the single most important risk factor for a poor outcome.[61,159,210,211] The poor-grade patients (Hunt and Hess or WFNS grade IV and V), 18–24% of the entire SAH population, present the greatest challenge to the neurointensivist. They have worse long-term functional outcomes and higher mortality rates.[159,212,213] However, early and aggressive treatment of patients with severe SAH resulted in unexpected improvements in the long-term outcome.[67,203,214–216] Of 26 patients with poor-grade SAH with neurocognitive testing at 1 year, half of the patients, mainly young and highly educated individuals, all employed in full-time jobs prior to SAH, had mild cognitive deficits and were able to live a normal life.[213]

Of equal importance, it should be noted that mortality rates are substantially higher and good long-term functional outcomes less common at centers that treat less than 18 patients with SAH per year.[69–71,217]