Emorragia subaracnoidea traumatica. Significato clinico e prognostico di questa non rara evenienza. Studio di 123 casi

In this study we have analyzed clinical and radiological patterns of 123 patients with diagnosis of traumatic subarachnoid haemorrhage (tSAH). Particular reference has been focused on computed tomographic (CT) patterns of amount of subarachnoid blood. 40.6% of patients had Glasgow coma scale (GCS) between 3 and 7, 26% between 8 and 12, 33.3% between 13 and 15. CT scan at admission showed a pure tSAH in 24.4% of cases, while in 61,8% of cases tSAH was associated with cerebral contusion alone or with other intracranial lesions and in 13.8% of cases tSAH was associated only with subdural or extradural hematomas. At a 2-months follow-up examination, 54,4% of patients were classified in Glasgow outcome scale (GOS) 1 and 2; 15.5% GOS = 3; 9% of patients GOS=4, while 21.1% of patients were dead. In 60.9% of cases tSAH was classified as grade 1, in 23.6% grade 2, in 10.6% grade 3 and in 4.9% grade 4. Statistical analysis revealed that tSAH is a negative prognostic factor and that the degree of tSAH are significantly related to the outcome of patients. If the presence of cerebral contusion, hematomas or pure tSAH are considered as single variable, neither significant correlation with GCS at admission, nor with GOS at 2-months follow-up examination were found. These data considered all together confirm that tSAH «per se» could be considered a negative prognostic factor independently on intracranial associated lesions and that the amount of subarachnoid blood is the most important feature influencing the follow-up of these patients.