We examined 258 patients with poor grade subarachnoid hemorrhage (SAH) (Hunt and Kosnik grade IV or V) in this study. Seventy-two patients (27.9%) were over 70 years old. Seventy-four (28.7%) of 258 patients suffered episodes of rebleeding. Of the 74 patients, 54 (73%) were under observation at home or in the primary care hospital without CT scan evaluation because they recovered consciousness after the initial attack. Fifty-seven percent of the rebleeding occurred at home, 28% in the primary care hospital, 9.5% in the ambulance, and 9.5% in our hospital. Eighty-eight patients (34.1%) suffered intracranial hemorrhage (intracerebral hemorrhage and intraventricular hemorrhage), and had to undergo emergency surgery. Sixty-three patients (24.4%) presented respiratory complications: 27 patients (10.5%) suffered from neuronal pulmonary lung edema and 36 patients (14.0%) suffered from aspiration pneumonia. Seven of the patients with neuronal pulmonary lung edema were examined through Swan-Ganz study. These patients showed a remarkably decreased cardiac index, increased SVRI and increased PCWP. Of the 258 patients, 237 presented electrocardiogram disorder. Sixteen of these (6.8%) needed treatment by a cardiologist.
Poor grade SAH patients suffer not only from intracranial complications but also from general complications due to a cathecolamine surge after the initial incident. These patients should be rapidly evaluated for treatment to prevent rebleeding, emergency operation and for treatment of general complications.
