Subarachnoid Hemorrhage in the Elderly

Subarachnoid hemorrhage (SAH) is a disease with high risk of mortality and morbidity. Elderly patients have an even higher risk of poor outcome. The incidence of SAH increases with age and the elderly constitute a substantial and increasing proportion of the population. Thus, the management of elderly SAH patients is an imminent clinical challenge. Time trends in clinical management and outcome were investigated in 281 SAH patients aged ≥65 years admitted over an 18-year period. The volume of elderly patients, especially patients ≥70 years and patients in worse clinical condition increased over time. The proportion of patients with favorable outcome increased over time, without an increase in severely disabled patients. Technical results and clinical outcome of endovascular aneurysm treatment (EVT) was investigated in 62 elderly SAH patients. EVT can be performed in elderly SAH patients with high technical success, acceptable aneurysm occlusion degree, acceptable procedural complication rate, and fair outcome results. EVT was compared to neurosurgical clipping (NST) in 278 elderly…


General review of subarachnoid hemorrhage
Symptoms and diagnosis
Natural course and overall clinical outcome
Primary brain injury
Aneurysm treatment
Cerebral vasospasm
Treatment of vasospasm
Secondary insult concept
Neurointensive care
Subarachnoid hemorrhage in the elderly
Physiological effects of normal aging
Conservative management in the elderly
Neurosurgical aneurysm treatment in the elderly
Endovascular aneurysm treatment in the elderly
Possible advantage of neurointensive care in the elderly
Cerebral vasospasm in the elderly
Aims of the investigations
General aim
Specific aims
Materials and Methods
Paper I
Data collection
Statistical analyses
Paper II
Data collection
Statistical analyses
Paper II
Data collection
Statistical analyses
Papers IV and V
Data collection
Statistical analyses (Paper IV)
Statistical analyses (Paper V)
Paper VI
Data collection
Statistical analyses
Grading scales
Neurological grading scales
Radiological grading scale
Outcome grading scales
Changes in management and outcome over time
Introduction of coiling in elderly SAH patients
Technical feasibility and aneurysm occlusion rate
Procedural complications
Coiling versus clipping in elderly SAH patients
Procedural complications
Adverse events
Secondary insults in severe subarachnoid hemorrhage
Definitions of secondary insults
Occurrence and distribution of secondary insults
Occurrence of secondary insults related to base characteristics
Age and occurrence of secondary insults
Secondary insults and functional outcome
Secondary insults and clinical deterioration
Outcome in elderly patients with severe SAH
Age and cerebral vasospasm
Age is not a predictor of cerebral vasospasm
Summary in Swedish

Author: Ryttlefors, Mats

Source: Uppsala University Library

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