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The problematic points in the management of severe cases of subarachnoid hemorrhage admitted within 24 hours after onset were studied based on laboratory findings obtained during the first 14 days hospitalization. The present study covered 106 cases classified as Hunt and Hess grades 4 and 5 (Group A) and 203 cases classified as Hunt and Hess grades 1-3, which were used as controls (Group B). First, blood pressure (BP), white blood cell count (WBC), serum sodium (Na), serum potassium (K), blood glucose (BG), GOT, GPT, LDH, CPK and CPK-MB (%), and ECG (heart rate (HR), QTc time, ST changes, giant T wave, inverted T wave and U wave) obtained on admission were examined. A significant difference (p<0.01) was observed between Group A and Group B in WBC, Na, K, BG, GOT, and LDH. WBC (normal: 9,000/mm3 or less) was elevated in both groups with the mean in Group A being 13,100/mm' and that in Group B being 11,600/mm3. The number of cases in Group A with Na and K values found to be lower than normal was significantly greater than that in Group B (p<0.01). The mean blood glucose level was significantly elevated in Group A (p<0.01) with the mean value being 214.4mg/d/ in Group A and 150.3mg/d/ in Group B. Almost all of the serum enzyme levels were within the normal limits in both groups. Abnormal ECG findings were observed in 79 out of 81 cases in Group A and in 170 out 192 cases in Group B. In particular, the incidence of such abnormal ECG findings as tachycardia, arrhythmia, prolongation of QTc time, ST changes, and inverted T wave was significantly elevated in Group A. Next, a study was made on the changes from day 0 to day 14 in BP, HR, body temperature (BT), Na and K. An increasing tendency was observed in Group A for HR and BT to deviate from the normal limits during the course. There were many cases in Group A where Na and K levels declined. An elevated incidence of abnormal laboratory findigs was observed during the acute stage of subarachnoid hemorrhage with the incidence being significantly elevated in severe cases when compared to light cases. These fingings indicate that subarachnoid hemorrhage during the acute stage should be managed as a systemic disease.

Clinical Data of Severe Cases in Acute Stage of Subarachnoid Hemorrhage