Approximately 28,000 individuals in North America have a subarachnoid hemorrhage from ruptured aneurysm each year. Most are young, healthy individuals with good neurological function after the hemorrhage who have the potential for returning to a vigorous and productive life. Many will develop devastating neurological deficits or perish, mostly from vasospasm and bleeding. Less than 60% of those who reach hospital will have a favorable outcome. There is considerable room for improvement. The long term objectives of this study are to decrease the mortality and morbidity of aneurysmal subarachnoid hemorrhage, principally by obtaining information which will lead to more effective management strategies for vasospasm and rebleeding. One approach entertained for decreasing these complications is early surgery which has many theoretically attractive features but remains one of the most controversial topics in neurosurgery. Accordingly, the principal aim of this study is to determine at which interval after subarachnoid hemorrhage surgery results in the most favorable outcome.
Other specific aims i nclude: determination of risk factors for rebleeding and the timing of these disastrous events; determination of the safety and effectiveness of antifibrinolytic agents and development of an administration schedule which optimizes the actions in preventing rebleeding and minimizes ischemic neurological complications; documentation of the diagnostic and prognostic value of CT scanning in subarachnoid hemorrhage; and development of a more reliable and universally acceptable neurological grading scale for patients with ruptured aneurysm.
