Clinical Evaluation of Subarachnoid Hemorrhage and Clinical Study of Etiologically Unknown Cases

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Abstract
This paper describes our method in examining the source of subarachnoid hemorrhage and the results obtained in 630 subarachnoid hemorrhage patients who visited our clinic during the last 6 years. Angiography was performed initially on the side corresponding with neurological findings. All cases underwent four-vessel angiography except for those in whom the source of hemorrhage was clearly noted as intracerebral hematoma or arteriovenous malformation. With the initial angiography, the source of hemorrhage was not clear in 119 cases (18.9%). Among them 72 patients showed a remarkable degree of hemorrhage and angiospasm in the main vessel. One to two weeks later, they were again subjected to four-vessel angiography, which revealed aneurysms in 5 cases and A-V malformations in 2 cases. In 51 cases who showed ventricular dilatation in angiography and remarkable neurological findings, PEG, PVG, or CVG was performed. With these methods the source of hemorrhage became clear in 20 patients. During the last 10 months, CT scan has also been used and this has enabled us to find intracerebral hematomas in 5 cases and brain tumor in 1 case. In cases of profuse subarachnoid hemorrhage with angiograms in main vessels at the base of the brain, ruptured aneurysm can be considered as the source of hemorrhage. However, in 5 cases in whom the source of hemorrhage was not found by angiography, craniotomy was performed. The arterial main trunk was examined and anterior communicating aneurysms were discovered in 3 patients and a middle cerebral aneurysm in 1 patient. No aneurysm was found in 1 case. Autopsies were performed on 11 patients out of 13 who died of unknown source of hemorrhage. Intracerebral hematomas were found in 8 and aneurysms in 3 cases. In 69 patients (11%), the source of hemorrhage could not be found by these methods. Among the 69 cases with unclear source of hemorrhage, two peaks of incidences were found; one in youth and the other in old age. Clinical symptoms were essentially the same as in these cases with clear sources of hemorrhage and the clinical courses and prognosis were clearly better in youth cases. There were no recurrences in follow-up studies and about 80% of the patients returned to completely normal life.

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