Current Concepts of Cerebrovascular Disease and Stroke Management of Aneurysmal Subarachnoid Hemorrhage

A neurysmal subarachnoid hemorrhage (SAH) Z A accounts for approximately 6-8% of all JL JL strokes. Unlike other forms of cerebrovascular disease, the incidence of SAH has not declined during the last 2 decades. Based on the US population and available data on the incidence of SAH (11/100,000), the calculated number of SAH cases per year is approximately 26,000. SAH is a serious disorder with a potential for high mortality. Approximately 10% of persons with aneurysmal SAH will die rapidly because of the consequences of SAH. The outcome in patients with aneurysmal SAH begs for improvement. Currently, about half of the patients die within 3 months, half of the survivors have a major disability, and about two thirds of those who have successful aneurysm obliteration never regain their prehemorrhage quality of life. The leading causes of morbidity and mortality are the neurological and medical sequelae of the initial hemorrhage, recurrent aneurysmal rupture, and ischemic deficits resulting from cerebral arterial vasospasm. Early recognition and prompt management of SAH is of critical importance, but unfortunately, pitfalls in diagnosis remain common.Computed tomography (CT), cerebrospinal fluid (CSF) analysis in CTnegative cases, and four-vessel cerebral angiography remain the standard methods of diagnosis. Several scales (Table 1) have been developed to forecast prognosis and assist in examining response to treatment, but they are subject to interobserver variability.One currently used scale is that of the World Federation of Neurological Surgeons.