Management of spontaneous aneurysmal intracranial haemorhage at charlotte maxeke Johannesburg academic hospital

Abstract

Title: Management of spontaneous aneurysmal intracranial haemorrhage at Charlotte Maxeke Johannesburg academic Hospital. Study design: This is a descriptive retrospective study of the clinical characteristics, Neurological imaging findings, surgical intervention and three months outcome of treatment amongst 102 patients with ruptured aneurysmal intracranial haemorhage. The patients were treated at the department of neurological surgery Charlotte Maxeke Johannesburg academic hospital (incorporating department of Neurosurgery of the university of the Witwatersrand,South Africa). The medical records of all patients admitted from June 2007 to May 2009 with spontaneous aneurysmal intracranial haemorrhage were included in the study. The surgical outcome were evaluated by using the Modified Ranking scale, the relationship of Hunt and Hess score, Fisher grading on outcome were also examined. Results: Amongst 102 enrolled cases, the age of the patient ranged between 25 and 78 years with a mean of 45 years, the peak aneurysmal frequency was in the age of 41- 50 years (4th decade of life), with the Male: Female ratio of 1: 1.2, majority of aneurysms were located on anterior circulation (94.6%) over (5.4%) on posterior circulation. The anterior communicating artery was highly affected with aneurysmal frequency of 43.8%, 36.2% were on middle cerebral artery and 11.4% on posterior communicating artery. The rate of multiple aneurysms amongst recruited patients was 2.9%.

The commonest presenting symptom was headache (97%) followed by nausea and vomiting (63%). Most patients were admitted with Hunt and Hess grade (iii) 71.6%, while 21.6% had grade (ii).

On Neuro imaging modality on CT scan indicated that60.8% were admitted with Fisher grade 3,35.3% had Fisher grade 4 and none of the patient had Fisher grade 1.

..