SUBARACHNOID HAEMORRHAGE. TIME SEQUENCE OF RECURRENCES AND THEIR PROGNOSIS

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Abstract
A series of 229 patients with clinically diagnosed subarachnoid hemorrhage was reported. The series consisted of patients who were hospitalized early after the bleeding and treated conservatively during the 1st 6-8 weeks. This made an evaluation of the natural history of the early stages of subarachnoidal hemorrhage possible. The overall mortality was 14% during the 1st attack of bleeding, and 51.9% during the 2nd attack. There were 73 patients with saccular aneurysms. These had a mortality of 13.7% during the 1st attack of hemorrhage. In the 2nd attack the mortality was 59.6%. The period with the highest risk of recurrences in patients with aneurysms occurred in the 2nd and the 3rd weeks. Three fourths of all recurrences occurred within the 1st 8 weeks. It was concluded that the 1st episode of bleeding is frequently of minor severity, with a lower mortality than reported in the literature. The 2nd attack occurs early and implies a grave prognosis. Some of the patients are in a fair clinical condition even on the day after the initial hemorrhage. Patients with subarachnoid hemorrhage should, therefore, be examined by angiography and evaluated for surgical treatment as soon as possible after the initial hemorrhage.