Subarachnoid Haemorrhage in Malta - Are outcomes adversely affected due to lack of a local neurovascular service?

Vella, Malcolm; Dingli, Nicola; Aquilina, Josanne; Debono, Anthony Galea; Vella, Norbert
May 2014
Malta Medical Journal;2014, Vol. 26 Issue 2, p2
Academic Journal
Objective: This study was performed to assess the incidence, treatment and outcome of non-traumatic Subarachnoid Haemorrhage (SAH) in an island which does not offer a neurovascular service and to determine whether such limitation is associated with a poor outcome. Method: Data of adult patients with a diagnosis of non-traumatic SAH was analysed retrospectively over a two-year period from January 01, 2009 to December 31, 2010. Results: The incidence of SAH in Malta is 3.16 cases per 100 000 population per year. An underlying aneurysm was found in 50% of all cases investigated with angiography. These patients were transported to the United Kingdom for definitve management and the outcome of all these patients at 6 months was excellent. (modified Rankin Scale of 0 or 1). Conclusions: With the incidence of non-traumatic SAH being in the low range, setting up an interventional neuroradiology service in our country to treat aneurysmal SAH would not have the required numbers to maintain expertise and would probably translate into worse clinical outcomes. Despite having geographical and logistic limitations, our standards of care and survival rates are not below those of other international centres. Outcomes for patients with low initial Hunt and Hess scores have not been adversely affected by the lack of a local neurovascular service.


Related Articles

  • Stenting is improving and stabilizing anatomical results of coiled intracranial aneurysms. Lubicz, Boris; Bandeira, Alexandra; Bruneau, Michaël; Dewindt, Aloys; Balériaux, Danielle; Witte, Olivier // Neuroradiology;Jun2009, Vol. 51 Issue 6, p419 

    Stent-assisted coiling (SAC) is an alternative to surgical clipping for the treatment of wide-necked intracranial aneurysms (IA). However, little information is available concerning the long-term results of this treatment. The aim of this study was to report the long-term clinical and anatomical...

  • Subarachnoid hemorrhage and negative angiography: clinical course and long-term follow-up. Fontanella, Marco; Rainero, Innocenzo; Panciani, Pier; Schatlo, Bawarjan; Benevello, Chiara; Garbossa, Diego; Carlino, Christian; Valfrè, Walter; Griva, Federico; Bradac, Gianni; Ducati, Alessandro // Neurosurgical Review;Oct2011, Vol. 34 Issue 4, p477 

    The aim of this study was to investigate the long-term natural history of nontraumatic angiogram-negative subarachnoid hemorrhage with typical pretruncal (P-SAH) and diffuse (D-SAH) pattern of hemorrhage. A retrospective review of 102 patients who experienced angiographically negative SAH at our...

  • Is 3D Digital Subtraction Angiography Really Perfect? Enlightenment from a Case with Both False Positive and False Negative Results. Fei Wang; Feng Chen; Hai-Ling Li; Peng Sun; Xiang-Ming Liu; Ting-Jian Yang; Hao-Qing Song // Biomedical Research (0970-938X);2015, Vol. 26 Issue 3, p543 

    The aim of this study was to report a case that underwent a craniotomy after primary preoperative cerebrovascular and 3D digital subtraction angiography (DSA) showed false results. DSA misdiagnosis and missed diagnosis of aneurysms were found, and the subject was subsequently treated...

  • Cerebral Arterial Fenestrations. COOKE, DANIEL L.; STOUT, CHARLES E.; KIM, WARREN T.; KANSAGRA, AKASH P.; YU, JOHN PAUL; GU, AMY; JEWELL, NICHOLAS P.; HETTS, STEVEN W.; HIGASHIDA, RANDALL T.; DOWD, CHRISTOPHER F.; HALBACH, VAN V. // Interventional Neuroradiology;May/Jun2014, Vol. 20 Issue 3, p261 

    Arterial fenestrations are an anatomic variant with indeterminate significance. Given the controversy surrounding fenestrations we sought their prevalence within our practice along with their association with other cerebrovascular anomalies. We retrospectively reviewed 10,927 patients undergoing...

  • Bilateral Vertebral-Artery-Dissecting Aneurysm Causing Subarachnoid Hemorrhage Cured by Staged Endovascular Reconstruction after Occlusion. Koh, Jun Seok; Ryu, Chang Woo; Lee, Seung Hwan; Bang, Jae Seung; Kim, Gook Ki // Cerebrovascular Diseases;Feb2009, Vol. 27 Issue 2, p202 

    The article presents a case study of a 44-year-old woman suffering from a sudden onset of headache, vomiting, and disturbance of consciousness who was diagnosed with a rare instance of subarachnoid hemorrhage (SAH) which was caused by bilateral vertebral-artery-dissecting aneurysm (VADA). The...

  • Clinical outcome and prognostic factors of patients with angiogram-negative and non-perimesencephalic subarachnoid hemorrhage: benign prognosis like perimesencephalic SAH or same risk as aneurysmal SAH? Konczalla, Juergen; Schuss, Patrick; Platz, Johannes; Vatter, Hartmut; Seifert, Volker; Güresir, Erdem // Neurosurgical Review;Jan2015, Vol. 38 Issue 1, p121 

    Subarachnoid hemorrhage (SAH) is usually caused by a ruptured intracranial aneurysm. However, in some patients, no source of hemorrhage might be detected despite repeated digital subtraction angiography (DSA). Our objective was to analyze factors influencing the clinical outcome in patients...

  • Anterior inferior cerebellar artery aneurysms: six cases and a review of the literature. Li, Xin; Zhang, Dong; Zhao, Jizong // Neurosurgical Review;Jan2012, Vol. 35 Issue 1, p111 

    Aneurysms of the anterior inferior cerebellar artery are rare. Six cases of anterior inferior cerebellar artery (AICA) aneurysms treated at one center are presented. The six cases of AICA aneurysms were surgically treated. The clinical features, surgical process, complications, and follow-up are...

  • When a clear crystal makes a case crystal clear. Benz, Rudolf; Züger, Max; Pung, Tamara; Gallus, Evelyn; Weisshaupt, Christian; Krause, Martin // Practical Neurology (BMJ Publishing Group);Dec2009, Vol. 9 Issue 6, p345 

    The article presents a case study of a 56-year-old patient who was taken to the emergency room for a three week history of non-resolving frontal headache. It mentions that the laboratory result demonstrates mild thrombocytosis and leucocytosis. It states that saccular aneurysm of the anterior...

  • Stent-assisted coiling in ruptured wide-necked aneurysms: A single-center analysis. Alurkar, Anand; Karanam, Lakshmi Sudha Prasanna; Nayak, Suresh; Oak, Sagar // Surgical Neurology International;2012, Vol. 3 Issue 1, p716 

    Background: To evaluate the safety and efficacy of stent-assisted coiling of ruptured intracranial wide-necked aneurysms in a setting of acute subarachnoid hemorrhage, without compromising on the antiplatelet regimen. Methods: Forty-two consecutive patients who underwent stent-assisted coiling...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics