Therapeutic Indications for Aneurysmal Subarachnoid Hemorrhage in Aged People

UEHARA Hisao, KAWASOE Takuma, MIYATA Shiro, FUJIME Kenichi, OHTA Hajime, ARIKAWA Shoji, NAKANO Shinichi, WAKISAKA Shinichiro, Hisao UEHARA, Takuma KAWASOE, Shiro MIYATA, Kenichi FUJIME, Hajime OHTA, Shoji ARIKAWA, Shinichi NAKANO, Shinichiro WAKISAKA, 宮崎大学医学部脳神経外科, 宮崎県立日南病院脳神経外科, 都城市郡医師会病院脳神経外科, 潤和会記念病院脳神経外科, Department of Neurosurgery Miyazaki Medical College University of Miyazaki, Miyazaki Prefectural Nichinan Hospital, Miyakonojo Medical Association Hospital, Junwakai Memorial Hospital

We assessed the therapeutic indications for aneurysmal subarachnoid hemorrhage (SAH) in aged people. Between April 1999 and March 2002, 142 patients with aneurysmal SAH were treated and enrolled in this study. They were divided into 3 groups: 33 patients 75 years old and older (Group A, 23.2%), 37 between 65 and 74 years old (Group B, 26.1%), and 72 64 years old and younger (Group C, 47.4). Hunt and Kosnik grades, Fisher's CT classifications and clinical outcome were evaluated in each group. Clinical outcome was measured by Glasgow Outcome Scale, and good recovery and moderately disabled were defined as favorable outcome. Group A had a significantly higher incidence of serious Hunt and Kosnik grades of patients compared with the other 2 groups (p< 0.05, <0.01). Fisher's CT classification was also more severe in Group A than Group C (p<0.05). Therefore the rate of radical treatments was significantly lower in Group A (45.5%) compared with Group B (73.0%) and C (86.1%). Only 4 of the 33 patients (12.1%) with favorable outcome were in Group A, whereas the rates of favorable outcome in Group B and C were 54.1 and 62.5%, respectively. Group A had a significantly poor outcome compared with the other 2 groups. Particularly, none of the patients in Group A with Hunt and Kosnik Grades 4-5 and Fisher's Classification 4 had favorable outcome. Since there were no significant differences in the rate of radical treatments and clinical outcome between Group B and C, aged people 74 years old and younger should be actively treated in the same manner as the young. In aged people 75 years old and older, however, radical treatment should be restricted to those with Hunt and Kosnik Grade 1-3 and Fisher's CT Classification 2-3.

Therapeutic Indications for Aneurysmal Subarachnoid Hemorrhage in Aged People

Bibliographic Information

Search this article

Description

Journal

Citations (3)*help

References(34)*help

Keywords

Details 詳細情報について

Export

Report a problem