Abstract
Objective
Patients suffering from aneurysmatic Subarachnoid Hemorrhage (SAH) may present with
a variety of symptoms. The aim of this study is to evaluate the spectrum of misdiagnoses
and to analyze the significance of delay of correct diagnosis on the clinical outcome.
Methods
The data was collected prospectively from 2003 to 2013. Patients diagnosed with disease
different from aneurysmal SAH by the initially treating physician, and admitted to
our department with a delay of at least 24 h after the beginning of the symptoms,
were included in this study. We analyzed the various diagnoses that were ascertained
instead of SAH and which medical specialty had provided them.
Results
Overall 704 patients were treated with acute SAH. The inclusion criteria were matched
in 76 patients (13.7%). Eleven specialties were involved in the initial patients'
treatment. The time interval between initial symptoms and neurosurgical admission
varied enormously. Statistically, higher Hunt & Hess score did not lead to an earlier
diagnosis (p = 0.56) nor did localisation of the aneurysm (p = 0.75). Lower Fisher score was led to delayed diagnosis (p = 0.02). Delay of diagnosis was not significantly associated with the outcome (p = 0.08) whereas Hunt & Hess grade on admission was a strong predictor for bad outcome
(p = 0.00001) as was cerebral vasospasm on the first angiogram (p < 0.05).
Conclusion
A straightforward diagnosis of SAH despite diffuse and unspecific symptoms is crucial
for the successful treatment of these patients, especially with high grade SAH.
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Article Info
Publication History
Published online: March 10, 2019
Accepted:
March 2,
2019
Received in revised form:
February 28,
2019
Received:
January 17,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
