Better diagnosis, treatments behind decrease, researchers say
WEDNESDAY, June 3 (HealthDay News) -- Better diagnosis and treatment have led to fewer deaths from the rupture of a blood vessel on the surface of the brain, Dutch researchers say.
Known as a subarachnoid hemorrhage, this kind of rupture leads to bleeding into the space between the brain and the thin tissue that covers the brain. It can occur spontaneously, usually from a weakness in a blood vessel or a head injury. In developed countries, the condition affects about eight in 100,000 people each year. It causes 5 percent to 10 percent of strokes, and about 30 percent of patients die within 24 hours. Of those who survive, more than 25 percent are left disabled, the researchers noted.
"Despite an increase in the mean age of patients with subarachnoid hemorrhage, case fatality rates have decreased by 17 percent between 1973 and 2002," said study author Dr. Dennis Nieuwkamp, from the University Medical Centre Utrecht. "This decrease coincides with the introduction of improved management strategies."
In the future, deaths might decrease even more due to newer diagnostic and therapeutic methods, Nieuwkamp added.
"This decrease will probably be limited by the substantial proportion of patients who die before reaching hospital or reach hospital in poor neurological condition," he said. "To decrease mortality from subarachnoid hemorrhage, the incidence could be further reduced by prevention strategies."
The focus should not only be on the death rate but also on disability, Nieuwkamp said. "This is important from the patients' perspective and from a societal perspective, because of the high costs from the loss of productive life-years and the long-term care of patients with subarachnoid hemorrhage who become and remain disabled from a young age," he explained.
Recent advances in diagnosis and treatments include CT and MRIs for finding aneurysms, and the spread of stroke units. In addition, new treatments have improved the outcome of patients who reach hospital in good condition and are suitable for these treatments.
The report is published in the June 4 online edition of The Lancet Neurology.
For the study, Nieuwkamp's team analyzed 33 studies conducted between 1973 and 2002 involving 8,739 patients.
The researchers found that although the average age of patients with the condition increased from 52 to 62, the odds of dying dropped from 51 percent to 35 percent. Nieuwkamp's group noted that deaths in Japan were 11.8 percent lower than in Europe, the United States, Australia and New Zealand. This difference may relate to faster hospital admission and treatment in Japan, they speculated.
Dr. Majaz Moonis, director of stroke services at the University of Massachusetts in Worcester, noted that although the reduction in deaths from subarachnoid hemorrhages is small, it is real.
"There is a small but real reduction in aneurysms and subarachnoid hemorrhage because of significant advancements in noninvasive imaging that identifies aneurysms early, and preventive treatment, mainly with endovascular coiling as well as medications," he said.
For more information on subarachnoid hemorrhage, visit the U.S. National Library of Medicine.
SOURCES: Dennis Nieuwkamp, M.D., University Medical Centre Utrecht, Utrecht, Netherlands; Majaz Moonis, M.D., director, stroke services, University of Massachusetts, Worcester, Mass.; June 4, 2009, The Lancet Neurology, online
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