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The relationship between subarachnoid hemorrhage (SAH) and chronic renal failure (CRF) remains unknown. We retrospectively reviewed 302 cases of SAH. Of these, 6 cases were diagnosed as CRF who needed hemodialysis. In the cases with hemodialysis, SAH of unknown origin was more frequent than in ordinary SAH cases (80.0% vs. 5.5%, P＜0.0001). No SAH occurred during hemodialysis. The frequency of SAH in the patients with hemodialysis seemed to have no relationship with the duration of hemodialysis. These results suggest that further investigation is needed to clarify the effect of hemodialysis on cerebral vessels, which may frequently lead to SAH of unknown origin.

We analyzed the outcome of patients over 80 years old with subarachnoid hemorrhage (SAH). We conducted a retrospectively evaluated the medical records and imaging studies of 49 patients treated with clipping, coiling or conservative therapy between January 2005 and December 2008. The patients were graded on admission, according to the World Federation of Neurological Surgeons (WFNS) grade, and modified Rankin Scale (mRS) at discharge. Forty-nine patients ranged from 80 to 94 (average 85.8). Seven patients were men. The WFNS grade on admission revealed that 14 patients were Grade 1, 8 Grade II, 4 Grade III, 6 Grade IV and 17 Grade V. Fourteen patients underwent surgical clipping, and 10 patients underwent coil embolization. Twenty-five patients recrived conservative therapy. The overall results evaluated as mRS at discharge were: 3 patients (6.1%) were mRS 0, 4 (8.2%) mRS 1, 4 (8.2%) mRS 2, 4 (8.2%) mRS 3, 10 (20.4%) mRS 4, 13 (26.5%) mRS 5, 12 (24.5%) mRS 6. While only 1 patient (4.2%) in the conservative group had a favorable outcome (mRS 0-3), 13 patients in the operative group (54.2%) had favorable outcomes: 8 patients (80.0%) who underwent coil embolization and 5 patients (35.7%) who underwent surgical clipping. Unfavorable outcomes were caused mainly by primary brain damage and symptomatic vasospasm. In elderly SAH patients, radical treatment of ruptured aneurysm is important to achieve a favorable outcome.

We retrospectively evaluated computed tomographic angiography (CTA) as the first choice of imaging for diagnosing ruptured cerebral aneurysms among 219 consecutive patients with non-traumatic subarachnoid hemorrhage (SAH) at our hospital between January 2001 and December 2004. We found ruptured cerebral aneurysms in 203 patients, and the first diagnostic method was Digital Subtraction Angiography (DSA) in 34 patients and CTA in 169. Complementary DSA was indicated in 27 of the latter group (CTA+DSA group), and the remaining 142 patients (CTA group) were treated based solely on CTA findings. We found that 22% of the CTA+DSA group (n=6) and 4.9% of the CTA group (n=7) (P These findings indicated that the probability of misdiagnosing multiple aneurysms is higher when they are barely visible on CTA images, and thus physicians should strive to acquaint themselves with progress in diagnostic modalities and select the most appropriate strategy for individual patients with aneurysmal SAH.