Outcome in patients with a poor prognosis after subarachnoid hemmorrhage

Patients with a subarachnoid hemorrhage (SAH) can present in a very poor condition, which is associated with a poor outcome. SAH patients are also prone to complications which can cause secondary deterioration.
Part 1 of the thesis focusses on complications after SAH: rebleeding and bacterial ventriculitis. To prevent rebleeding the aim is to initiate aneurysm treatment as soon as possible. Independent factors contributing to the delay in time to treatment are presentation at a referring hospital and admission at a treatment center later in the day. A bacterial ventriculitis after an SAH is difficult to diagnose due to influx of red blood cells in the cerebrospinal fluid (CSF). Only in 5% of the SAH patients the CSF culture is positive. In the patients who were suspected to have a bacterial ventriculitis, only a longer duration of CSF drainage and lower CSF red blood cell counts predicted for culture-positivity.
In part 2 the treatment decisions in poor-grade patients are explored. Most poor-grade patients die because of withdrawal of life-support. This leaves room for the probability that there are possibly patients who would have had a better prognosis if given more time to recover. An expeditious treatment approach in poor-grade patients is sown to lead to a better outcome. We researched disease-related characteristics, present at admission, which could possibly identify poor-grade patients who would benefit from aggressive treatment. Symptoms like fixed and dilated pupils or a low Glasgow Coma Scale were found not to discriminate enough.