Stroke, Vol 16, 591-594, Copyright © 1985 by American Heart Association
R Bonita and S Thomson
A population-based study of primary subarachnoid hemorrhage in Auckland
(population 829,454), New Zealand, identified 180 cases in a two-year
period. This represented an age adjusted incidence rate of 10.5 and 18.3
per 100,000 for men and women respectively. Sixty-eight percent of all
cases had a proven intracranial aneurysm or arteriovenous malformation, 15%
had negative angiographic findings and in the remaining 17%, the presence
or absence of a localized lesion was unknown since neither angiography nor
autopsy were performed. Twenty- six patients (15%) died before
hospitalization and a further 36 patients (20%) died within 48 hours of
onset. Only 94 patients (53% of all patients registered) were fit enough to
undergo angiography. A surgical operation was carried out on 60 of the 68
patients in whom an aneurysm was confirmed at angiography. The overall case
fatality rate was 36% within the first 48 hours, 43% in the first week and
57% at both six months and one year. The high early case fatality rates are
similar to those found in previous population-based studies, suggesting
that despite the major advances to individual patients from technological
advances, the potential contribution of hospital management to the
reduction of subarachnoid haemorrhage mortality rates is likely to be
limited.
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