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(Stroke. 2007;38:1222.)
© 2007 American Heart Association, Inc.

Original Contributions

Life Expectancy After Perimesencephalic Subarachnoid Hemorrhage

From Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Centre, Utrecht, The Netherlands.

Correspondence to G.J.E. Rinkel, MD, Professor of Neurology, Department of Neurology, Rm G03.228, University Medical Centre Utrecht, Heidelberglaan 100, 3484 CX Utrecht, The Netherlands. E-mail g.j.e.rinkel{at}umcutrecht.nl

Background and Purpose— Patients with a perimesencephalic nonaneurysmal subarachnoid hemorrhage are not at risk for rebleeding in the initial years after the hemorrhage. Nevertheless, uncertainty remains on the long-term prognosis after perimesencephalic hemorrhage, and former patients are often considered high-risk cases for health insurance or are denied life insurance. We performed a very long-term follow-up study of a large consecutive series of such patients and compared mortality in this cohort with that in the general population.

Methods— All patients with a perimesencephalic hemorrhage (defined by pattern of hemorrhage on computed tomography within 72 hours after onset and absence of aneurysm) admitted between 1983 and 2005 to our service were followed-up by telephone. For patients who had died, we retrieved age and cause of death. We compared the age- and sex-specific mortality of this cohort with that of the general population by means of standardized mortality ratios with corresponding 95% confidence intervals.

Results— The cohort consisted of 160 patients, with a total number of patient-years of 1213. No new episodes of subarachnoid hemorrhage had occurred. During follow-up 11 patients had died; the expected number of deaths based on mortality rates in the general population (adjusted for age and gender) was 18.1. The standardized mortality ratio was 0.61 (95% confidence interval, 0.34 to 1.1).

Conclusions— Patients with perimesencephalic hemorrhage have a normal life expectancy and are not at risk for rebleeding. No restrictions should be imposed on these patients by physicians or health or life insurance companies.

Key Words: epidemiology • perimesencephalic hemorrhage • subarachnoid hemorrhage