Registro Nacional de la hemorragia subaracnoídea en Uruguay: descripción de los primeros 36 casos

Abstract

Introduction: The SAH constitutes from 3 to 5% of all strokes in general population. It is a disease of high impact on society, because of its high morbidity and mortality. Multiple retrospective studies have been carried out, but there is no updated national prospective study of this pathology in Uruguay. Preliminary data from an annual study are published here with the aim of knowing the demographic, epidemiological characteristics, as well as the topographic and morpho-structural characteristics of aneurysms, and the evolution of patients with this pathology. Materials and Methods: A multicenter study of a prospective longitudinal cohort of all patients who presented with SAH in Uruguay in a period of one year is carried out, including in this first analysis all patients between November 1,2019 and January 31,2020. All patients older than 18 years who consulted were included. They were diagnosed with spontaneous SAH. Once the diagnosis of SAH was made, depending on the severity of the patient, a vascular study was performed (angio-CT or arteriography) to assess the presence or absence of aneurysm, and the topography of it to decide the treatment. The following variables were analyzed: age, sex, geographical origin, history, reason for consultation, Glasgow Coma Scale (GCS), World Federation of Neurological Surgeons (WFNS) scale, Hunt and Hess scale, Fisher scale, previous consultations. at admission, indicated treatment, complication related to SAH, complication related to indicated treatment, and modified rankin scale (mRS) at month. A capture mask was created, and the analysis was processed using SPSS version 22 software. The research was approved by all the Ethics Committee of the different centers that participated in the study. Results: out of a total of 36 patients, the average age was 55,2 years, more frequently in females. In 83,3% of the patients the predominant symptom was headache and in half of the cases it was associated with vomiting. Loss of consciousness occurred in 55% of cases. There was a 25% diagnostic error. The diagnostic study of the most frequent aneurysm used was CT angiography in 80% of cases, and arteriography was performed in 41%. Open surgery was performed in 63% of cases, and endovascular treatment in 14 % of cases. The most frequent aneurysms were anterior communicant, sylvian and posterior communicating. 80% presented complications related to their SAH. 30 days after stroke, 11 patients (30%) died (mRS 6), in the great majority of cases the cause was neurological. We must emphasize that the majority of patients who died were admitted with a poor neurological status. Conclusions: This paper presents the first figures on the annual incidence and epidemiological characteristics of Subarachnoid Hemorrhage in Uruguay.