We investigated clinical features in elderly patients with ruptured intracranial aneurysm in comparison with younger patients. A total of 199 patients older than 50 years underwent surgical treatment within 72 hours of the first onset. The patients were classified into three groups: those aged 50 to 59 years (Group A: 98 patients, 49%), those aged 60 to 69 years (Group B: 71 patients, 36%), and those aged 70 years or older (Group C: 30 patients, 15%)
We defined the“elderly”patients as those aged 70 years or older, because the management outcome in Group C was significantly worse than that in Group B (p<0.05), while no significant difference was shown between that in Group A and B. In Group C, the patients in Hunt and Kosnik Grades I and II were significantly fewer than those in Group A or B (p<0.05).
No significant difference was observed in the incidence of symptomatic vasospasm between Group C and other groups. The incidence of hydrocephalus in Group C was significantly higher than that in Group B (p<0.05). The main obstacles to the induced hypertension therapy were systemic complications in Group C, in which only 4 patients underwent this treatment. The overall outcome of the patients with preoperative hypertension was significantly poorer than those without it (p<0.01), and the mortality rate was higher in Group C (50%, 6 in 12 patients). In Group C, the outcome was obviously poor in the patients with postoperative complications (pneumonia, myocardial infarction, severe systemic infection, and so on), and all the patients remained disabled or died.
In elderly patients, brief and effective therapies should be administered in the treatment of symptomatic vasospasm to prevent systemic complications that might confine patients to bed for a long time.
