Abstract
The problematic points in the superacute stage of subarachnoid hemorrhage patients were studied by classifying the patients into two age groups. The subjects of the present study were 104 patients who were hospitalized within six hours following subarachnoid hemorrhage attack with 38 cases being over 60 years of age (Group A) and 66 cases being less than 60 years of age (Group B). When classified by the grade of Hunt & Kosnik at time of admission, 34 cases belonged to Grades I and II, 28 cases to Grade III, 16 cases to Grade IV, and 26 cases to Grade V. Rerupture within six hours which is the most problematic point was observed in 13 out of 104 cases (12.5%) with the rate in Group B being 12 out of 66 cases (18.2%) which is higher than the rate in Group A of one out of 38 cases (2.6%). In examining the rerupture cases of Group B by grade at time of admission, the rate was two out of 24 cases (8%) belonging to Grades I and II, six out of 22 cases (27%) belonging to Grade III, and four out of eight cases (50%) belonging to Grade IV, demonstrating an elevation in rate with severity of grade. Cerebral angiography was performed on 64 cases within six hours following onset. Rerupture developed prior to angiography in nine cases, during angiography in three cases, and following angiography in one case. It is considered that cerebral angiography within six hours after onset should be avoided, being a risk factor of rerupture.
Early operation within day 2 was conducted on 55 cases. In Group A, early operation was conducted on six out of ten cases (60%) belonging to Grades I and II and on four out of six cases (67%) belonging to Grade III, while in Group B, early operation was conducted on 16 out of 24 cases (67%) belonging to Grades I and II and on 15 out of 22 cases (68%) belonging to Grade III. The reasons why early operation could not be conducted on cases belonging to Grades I and II and Grade III were complication chiefly of the respiratory system in Group A and aggravation of condition following rerupture in Group B. Serum electrolyte imbalance and electrocardiographic abnormality were observed at the high rate in both groups, but these were not fatal. The important problematic points in the superacute stage are regarded to be rerupture in the young age group and complication in the old age group. It is considered that even in the old age group the range of feasibility of early operation can be expanded through the control of complications with the support of all branches of medicine.
