OBJECTIVE: To determine the current recovery rates and causes for morbidity and 
mortality in patients suffering aneurysmal subarachnoid hemorrhage (SAH).
METHODS: We reviewed a recent consecutive series of 95 patients with ruptured 
intracranial aneurysms who presented to our hospital between 1994 and 1995. When 
administered, active treatment consisted of early surgery for aneurysm clipping 
and aggressive prevention and treatment of SAH-related complications.
RESULTS: Eighty-eight (93%) of the patients were admitted within 24 hours of 
rupture. One-quarter of the patients in this series did not undergo aneurysm 
clipping due to poor neurological condition on presentation. Of the 75 patients 
initially considered for active treatment, 83% underwent surgery within 48 hours 
of rupture, all received nimodipine, 16% received tissue plasminogen activator 
to lyse subarachnoid or intraventricular clots, 40% underwent hypertensive 
treatment, and 7% underwent transluminal balloon angioplasty for vasospasm. At 
one year followup, 29% of patients had died, 7% had severe disabilities, 13% had 
moderate disabilities, 51% had made a good recovery, and 64% of all surviving 
patients had returned to their previous work status. Primary and contributing 
causes of death and disability, affecting 47 patients at one year, were: direct 
effects of the initial hemorrhage (79% of affected patients), surgical 
complications (13%), vasopasm (11%), rebleeding (11%) and medical complications 
(13%).
CONCLUSIONS: Almost two-thirds of patients suffering aneurysm rupture make a 
satisfactory recovery with modern treatment. While vasospasm has become a less 
common cause of poor outcome following SAH, surgical complications remain an 
important problem.