At the Institut of Pathology and the Institut of Forensic Medicine at the Charit? Clinics of the Humboldt-University Berlin from 1979 to 1984 took place 13,622 necropsies. Among them were 75 cases of fatal ruptures of intracranial aneurysms. This paper gives a description of the resulting subarachnoid hemorrhages (SAH) and compares them with the pathologic-anatomical findings. 65 cases have been utilized, in 50% of them the patients died on the day of bleeding, in no case the aneurysm was verified before death. 31% of the patients survived longer than one week. A sufficient prognostic sign was the degree of unconsciousness during the 24 hours following SAH. The morphological findings (intracranial hematomas, brain edema) and the time of further survival did not correlate. Ventricular hematomas were found in 49% of the autopsy subjects. Patients with ventricular hematomas from the initial SAH evolved a bad clinical state (Botterell Grading 'IV or 'V). Every nontraumatic SAH is a case of emergency which requires a fast diagnostic procedure. Ruptured aneurysms have to be excluded. A good clinical state after SAH need not keep stable. Grading systems reflect intracranial processes only incompletely.
Adult Aged