Subarachnoid hemorrhage in the eighties: to treat or not to treat

BACKGROUND: Life expectancy has in the last few years increased and, as a consequence, also the number of elderly patients admitted to an Emergency Department with aneurysmal subarachnoid hemorrhage. We wanted to detect any difference in term of outcomes and adverse events between two groups of patients of different age, in relation to types of treatment and clinical status at presentation. METHODS: We selected and analyzed two groups of patients (group A and group B) among 458 retrospectively collected cases admitted to two neurosurgical centers with a diagnosis of aneurysmal subarachnoid hemorrhage over a 7.5-year period. Group A included 46 patients equal or older than 80 years and group B all the rest. Data were collected on age, sex, aneurysm location, size, comorbidities, clinical condition at presentation and at follow-up. RESULTS: In group A, 19 patients underwent surgery, 16 were embolized, 7 were treated conservatively and 4 died very soon after admission. After a median follow-up of 12 months 45.7% of patients had a good outcome, 24% were in poor conditions and 21.7% had died. When we compared these results with the youngest group, we found some important statistically significant differences. Older patients were more prone to have surgical and medical related complications, whereas endovascular treatment seemed to be a more sustainable treatment in the elderly age group. CONCLUSIONS: Elderly patients suffering from aneurysmal subarachnoid hemorrhage should be considered for treatment despite age, with endovascular embolization as the most preferable option. Without the treatment, the natural history can be very poor.