eMedicine Specialties > Neurosurgery > Vascular

Subarachnoid Hemorrhage: Follow-up

Author: Jennifer Oman, MD, Associate Clinical Professor, Department of Emergency Medicine, University of California at Irvine
Coauthor(s): Sean David Lavine, MD, Assistant Professor of Neurosurgery and Radiology, Columbia College of Physicians and Surgeons; Adjunct Assistant Professor of Radiology and Neurological Surgery, Weill Medical College of Cornell University; Clinical Director, Neuroendovascular Services, New York Presbyterian Hospital, Columbia Presbyterian Medical Center
Contributor Information and Disclosures

Updated: Aug 3, 2009

Outcome and Prognosis

Despite advances in medical and surgical therapy, the mortality rate for aneurysmal SAH remains 50% at 1 year.

Survival is inversely proportional to SAH grade upon presentation. Reported data demonstrate an approximate 70% survival rate for Hunt and Hess grade 1, 60% for grade 2, 50% for grade 3, 20% for grade 4, and 10% for grade 5.

Approximately 25% of survivors have persistent neurologic deficits.

Most survivors have either a transient or a permanent cognitive deficit.

Mortality and morbidity are influenced by the magnitude of the bleed, the age of the patient, the presence or absence of comorbid conditions, and the occurrence of medical complications.

For excellent patient education resources, visit eMedicine's Headache Center and Procedures Center. Also, see eMedicine's patient education article Aneurysm, Brain and Spinal Tap.

Future and Controversies

The future of SAH management most likely will revolve around the continuing development and refinement of minimally invasive endovascular techniques.

Currently, controversy remains regarding the question of which aneurysms are appropriate for surgical or endovascular treatment; rigorous studies coupled with additional clinical experience will help with the formation of guidelines. Some aneurysms may require a combined approach.

While GDC therapy is, to date, the most promising development in the realm of endovascular methodologies for SAH, the future almost certainly will provide materials that are even safer and more efficacious in occluding aneurysms.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor, Todd Newton, MD, to the development and writing of this article.



More on Subarachnoid Hemorrhage

Overview: Subarachnoid Hemorrhage
Workup: Subarachnoid Hemorrhage
Treatment: Subarachnoid Hemorrhage
Follow-up: Subarachnoid Hemorrhage
Multimedia: Subarachnoid Hemorrhage
References
Further Reading
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Further Reading

Clinical guidelines

Acute stroke management. Management of subarachnoid and intracerebral hemorrhage. In: Canadian best practice recommendations for stroke care: 2006. Ottawa (ON): Canadian Stroke Network, Heart & Stroke Foundation of Canada; 2006. p. 61-3.

Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW, American College of Emergency Physicians. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. Ann Emerg Med 2008 Oct;52(4):407-36. 5

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Keywords

SAH, nontraumatic subarachnoid hemorrhage, nontraumatic SAH, extravasation of blood into the subarachnoid space between the pial and arachnoid membranes, spontaneous atraumatic intracranial hemorrhage, ruptured cerebral aneurysm, ruptured arteriovenous malformation

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Contributor Information and Disclosures

Author

Jennifer Oman, MD, Associate Clinical Professor, Department of Emergency Medicine, University of California at Irvine
Disclosure: Nothing to disclose.

Coauthor(s)

Sean David Lavine, MD, Assistant Professor of Neurosurgery and Radiology, Columbia College of Physicians and Surgeons; Adjunct Assistant Professor of Radiology and Neurological Surgery, Weill Medical College of Cornell University; Clinical Director, Neuroendovascular Services, New York Presbyterian Hospital, Columbia Presbyterian Medical Center
Sean David Lavine, MD is a member of the following medical societies: American Association of Neurological Surgeons, Congress of Neurological Surgeons, and Neurosurgical Society of America
Disclosure: Nothing to disclose.

Medical Editor

Paul L Penar, MD, Professor, Department of Surgery, Division of Neurosurgery, University of Vermont School of Medicine
Paul L Penar, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, and Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

 
 
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