Prognostic analysis of patients with high-grade aneurysmal subarachnoid hemorrhage complicated with acute intracranial hematoma

Objective To analyze the clinical prognosis of high - grade aneurysmal subarachnoid hemorrhage (aSAH) patients with different amounts of hematoma. Methods A total of 211 patients with high - grade aSAH hospitalized in Norhern Jiangsu People's Hospital from September 2013 to December 2020 were included. According to the intracerebral hematoma volume, they were divided into non - hematoma group (n = 105), hematoma volume < 50 ml group (n = 69) and hematoma volume ≥ 50 ml group (n = 37). All of them underwent aneurysm clipping or embolization. The modified Rankin Scale (mRS) was used to evaluate the clinical prognosis 6 months after surgery. Results Among 211 cases, 139 (65.87%) underwent aneurysm clipping and 72 (34.12%) underwent aneurysm embolization. Except for 3 patients who failed to successfully clamp and underwent decompression with bone flap due to intraoperative malignant encephaloceles, the remaining 208 patients were successfully clipped, and no aneurysms ruptured and bled again after surgery. There were 58 patients (27.49%) with good prognosis, 59 patients (27.96%) with poor prognosis, and 94 patients (44.55%) with death. The difference in neurological function prognosis among the 3 groups was statistically significant (χ2 = 7.424, P = 0.024). Among them, the mortality rate in hematoma volume ≥ 50 ml group was higher than that in non-hematoma group (Z = - 2.655, P = 0.008). The incidence of complication was 95.73% (202/211) in all patients, including 95.24% (100/105) in non - hematoma group, 95.65% (66/69) in hematoma volume < 50 ml group, and 97.30% (36/37) in hematoma volume ≥ 50 ml group. The difference in complication among the 3 groups was not statistically significant (χ2 = 0.284, P = 0.867). Conclusions The prognosis of high - grade aSAH patients with intracerebral hematoma is poorer, especially in high-grade aSAH patients with hematoma volume ≥ 50 ml, and have a higher mortality rate.