Aneurysm-related subarachnoid hemorrhage and acute subdural hematoma: single-center series and systematic review

Abstract

Object Subarachnoid hemorrhage (SAH) with simultaneous acute subdural hematoma (SDH) is a severe disease. The authors' objective was to analyze the incidence, prognosis, and clinical outcome of patients suffering from aneurysm-related SAH and space-occupying acute SDH. Methods Between June 1999 and June 2011, data from 989 patients with aneurysm-related SAH were prospectively entered into a database. Eighteen patients (1.8%) presented with aneurysm-related SAH and space-occupying acute SDH. The treatment decision (clip or coil) was based on an interdisciplinary approach. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months and was dichotomized into favorable outcome (mRS Score 0–2) versus unfavorable outcome (mRS Score 3–6). PubMed was searched for published studies of aneurysm-related SAH and acute SDH to gain a larger population. A multivariate regression analysis was performed on the pooled data. Results Literature data, including the current series, revealed a total of 111 patients. Overall, 38 (34%) of 111 patients with aneurysm-related SAH and acute SDH achieved favorable outcome. Favorable outcome was achieved in 68% of patients with good-grade clinical presentation on admission (Hunt and Hess Grades I–III) versus 23% of the patients with poor-grade presentation (Hunt and Hess Grades IV and V, p < 0.0001). In the multivariate analysis, poor clinical condition at admission was the only predictor for unfavorable outcome (p = 0.02). Conclusions The present data confirm that patients with aneurysm-related SAH and acute SDH, even when presenting in poor clinical condition, might achieve favorable outcome. Therefore, treatment of patients with SAH and acute SDH should not be discontinued, but careful individual decision making is necessary for each patient.