Retrospective analysis on aneurysmal subarachnoid haemorrhages at a single centre in Johannesburg, South Africa

Abstract Background Aneurysmal subarachnoid haemorrhages (aSAH) have global variation in epidemiology, risk factors, management and outcomes. Data from Africa remain limited, particularly regarding endovascular management and functional recovery. Methods We conducted a 7-year retrospective single-centre review of patients admitted with aSAH to a tertiary hospital in Johannesburg, South Africa (June 2015-June 2022). Demographic, risk factor, clinical, radiological, management and outcome data were collected. Outcomes were assessed at discharge using the modified Rankin Scale (mRS). Results 137 patients were identified with a mean age of 47.6 years, 65.0% were female and 80.3% were Black. Hypertension was the most prevalent risk factor (56.9%). Headache was the leading presenting symptom (81.8%), and most patients (71.5%) presented with WFNS of 1 to 3. Most aneurysms were in the anterior circulation (94.9%) and saccular in morphology (90.5%). Management was predominantly endovascular, with coiling performed in 87.6% of cases. A good functional outcome (mRS 0–2) was seen in 67.2% of patients. Higher WFNS and H&H grades, and IPH was associated with clipping. WFNS and H&H had the strongest association with poor outcomes. Conclusion This study presents one of the few African reports documenting predominantly endovascular management of aSAH, with 87.6% of patients treated by coiling and 67.2% achieving a good functional outcome (mRS 0–2). Clinical severity at presentation, as measured by WFNS and H&H grades, was the strongest independent determinant of poor prognosis and should guide treatment decisions and prognostic counselling at African neurosurgical centres.