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.