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The Department of Neurosurgery, Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Kashmir, sought to analyze all cases of subarachnoid hemorrhage (SAH) admitted from January 1983 to June, 2010 (27 years). The incidence of SAH in Kashmir at a given time is approximately 13/100000 population years. Of 2923 stroke patients admitted, SAH comprised of 31.02% (907/2923) with 92.06% adults and 7.93% children revealing a male: female ratio of 1.0: 1.78 (300 males: 535 females). The familial SAHs were 8.37% and familial aneurysms 8.51% common. The rupture of a saccular aneurysm was the most common (54.35%) cause of SAH in 191 males, 297 females and 5 children as detected by the carotid, digital subtraction and CT-angiography. The most common (36.10%) aneurysmal site was anterior communicating artery. About 30.83% aneurysmal patients had double/multiple aneurysms, thus more than 705 aneurysms were found in 493 patients. The arterio-venous malformation (AVM) in children was the commonest (65.51%) cause of SAH. The diagnostic tools of choice were lumbar puncture, carotid angiography and plain CT-scan brain. However CT angiography emerged as a better alternative to digital subtraction angiography, in revealing aneurysms and AVMs. While 35.61% cases were in Hunt-Hess poor grade (IV and V) with 63.15% deaths, an overall mortality of 36.60% in all SAH cases was observed. The initial bleeding episode led to 24.26% mortality while rebleeding occurred in 28.96% surviving cases and caused 12.35% mortality. A total of 32.04% aneurysms died. Good recovery was seen in 14.99% SAH cases and 19.6% aneurysmal ruptures. Noted finding was intra-operative enlargement of aneurysms that appeared smaller pre-operatively on CT-angiography. The special risk factors are ‘Jejeer’ Smoking and ‘Salt-Tea’ twice a day.
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Author(s): Abdul Rashid Bhat Mohammed Afzal Wani Altaf R Kirmani AU Ramzan Shafiq Alam Tariq Raina Ashish Kumar Jain Sajad Arif MA Laharwal Basharat MK
Subarachnoid hemorrhage, aneurysms, Kashmir, outcome