Description

The incidence of aneurysmal subarachnoid haemorrhage (SAH) increases with age, hence with rising average life expectancy we can expect increasing numbers of cases requiring care. Early diagnosis and early intervention are the key determinants of successful management. The diagnosis is based on a suggestive clinical history, with confirmation using CT brain scanning. Both the management strategy and prognosis are heavily dependent upon the clinical presentation and progress rather than age itself. Those who achieve a good neurological grade after resuscitation generally fare well with active treatment, whereas those who remain in coma usually have poor outcomes. Common complications of SAH, such as hydrocephalus and vasospasm, are readily treatable. Advances in, anaesthesia and microsurgical techniques, the introduction of interventional methods to secure vascular anomalies and neuro-intensive care have all contributed to improved outcomes. The focus of this review is to distinguish SAH from other forms of stroke in older people, and present the rationale for early intervention irrespective of advanced age and co-morbidities.