Spontaneous Subarachnoid Haemorrhage At Kenyatta National Hospital (K.N.H) (A Prospective And Retrospective Study Of Patients Seen In K.N.H. From July 1983 To July 1984 And July 1974 To June 1983 Respectively).
Abstract
A total of 109 patients with spontaneous subarachnoid
haemorrhage were included in this study 80 of
these patients belonged to retrospective group covering
a ten year period from July 1974 to June 1983 and 29
patients formed a prospective group covering a thirteen
months period from July 1983 to July 1984. The
two groups of patients were analyzed separately and
the results of analysis compared.
Males were more than females and the male to
female ratio was 2.5:1 and 2.6:1 in retrospective
and prospective group respectively. Age range was
15 to 90 years in retrospective group and 20 to 90
years in prospective group. Males were slightly
older than females. The mean age was 47.52% 18.72
and 36.50± 15.02 in males and females respectively
in the prospective group. The peak incidence was in
20 - 50 age group which comprised over 60 percent of
the patients. The younger the patient the better was
the outcome with best recovery below 40 years. There
was no difference in outcome between the sexes.
In prospective study, alcohol was observed to
be the leading factor of association in 35 percent of
patients. Hypertension was found in 24 percent and
smoking found in 17 percent. Both alcohol and smoking
were associated with the largest n:umber of intracranial
vascular abnormalities (4 out of 9 aneurysms and one
arteriovenous malformation).
The largest group of patients had normal angiographic
findings and formed 44 percent in prospective
group, 70 percent in retrospective group and 61 percent
when the two groups were combined. Aneurysms
were the second largest group of subarachnoid haemorrhage.
They formed 33 percent in prospective group, 20
percent in retrospective group and 24 percent when the
two groups were combined. Intracerebral haemorrhage was
third. It formed 19 percent in prospective group, 5
percent in retrospective and 10 percent when the two
groups were combined. Arteriovenous malformation was
last and formed 4 percent in prospective group, 3 percent
in retrospective and 4 percent when the two were
combined. Normal angiographic findings had best prognosis
followed by the group with aneurysms. Intracerebral
haemorrhage had grave prognosis with 100 percent mortality
in prospective group.
The commonest site of aneurysm in each separate
group and when combined was posterior communicating
artery which had 45 percent of the aneurysms. Ant-erior
cerebral and anterior communicating artery was
second with 25 percent, carotid artery had 15 percent,
middle cerebral artery 10 percent and basilar artery
5 percent.
Electrocardiographic changes were found in 73
percent of all the patients investigated, in 68 percent
of the control group and in 78 percent of the
propranolol group.
Patients on propranolol showed a trend of short
recovery period compared with control group (8 and 13
days respectively). There was also a trend of better
outcome for the propranolol group than the control
group.
The serum cholesterol levels, urinary 17-ketosterOid,
17-Hydroxysteroid, vanillyl mandelic acid
and catecholamines were normal.
Citation
Master of medicine,University of Nairobi,1985.Publisher
University of Nairobi medicine