DOI: 10.31832/smj.1884570 ISSN: 2146-409X

Subarachnoid Hemorrhage in the Emergency Setting: Diagnostic Yield, Clinical Course, and Predictors of Functional Recovery

Samet Öncel, Abdulkadir Tunç, Derya Kara Genç, Büşranur Kaplan, Büşra Bozdoğan Özyavuz, Esra Ünal, Şule Dalkılıç, Türkan Acar
Show PDF Cite
Objective: Subarachnoid hemorrhage (SAH) remains a substantial neurological emergency. Data on diagnostic timing, etiologic distribution, and prognostic factors across SAH subtypes are limited in emergency department (ED)-based cohorts.Methods: We retrospectively reviewed 110 patients presenting with suspected SAH between 2018-2024. Demographic and clinical features, imaging patterns, etiology, comorbidities, complications, and treatments were extracted. Outcomes were assessed at one month using Glasgow Coma Scale (GCS), modified Rankin Scale (mRS), and Hunt & Hess (H&H) grades.Results: The cohort (mean age 53.2 ± 16.8 years; 60.9% male) frequently exhibited hypertension (24.5%). Leading presentations were trauma (32.7%) and headache (33.6%); sentinel headache occurred in 12.7%. Nearly all patients (89.1%) underwent non-contrast CT within 6 hours. SAH etiology was traumatic (53.6%), aneurysmal (24.5%), and spontaneous (21.8%). Mean admission GCS was 12.6 ± 3.6. Complication rates were low (rebleeding 4.5%, delayed cerebral ischemia 2.7%, vasospasm 0.9%). Traumatic SAH, despite lower admission GCS, was associated with higher rates of functional improvement (GCS 61.0%, mRS 74.6%) and fewer comorbidities compared to spontaneous/aneurysmal subtypes. Younger age (mRS and H&H analyses) and absence of comorbidities (GCS analysis) were associated with improvement, whereas patients who were fully alert at admission were less likely to meet the improvement criterion. Sentinel headache and nimodipine use clustered among non-improvers, likely reflecting disease severity. CT bleed pattern and H&H grade were not significantly associated with outcome.Conclusions: Traumatic SAH predominated in this ED-based cohort and showed more favourable one-month recovery than spontaneous subtypes. Admission clinical severity was the factor most consistently associated with functional change, although this association is constrained by the ceiling inherent to a change-based outcome definition. Early imaging and rigorous vascular evaluation remain essential, and larger etiology-stratified studies using absolute outcome measures are warranted.

More from our Archive