Objective: The trend in the initial severity of aneurysmal subarachnoid hemorrhage (SAH) is unclear. This study aimed to evaluate whether there was an improvement in the initial severity of SAH over time.Methods: From January 1, 2005, to December 31, 2020, we identified patients who visited the emergency department of our institution with SAH due to intracranial aneurysm rupture. We identified the Hunt Hess (HH) grade and modified Fisher grade of each patient from the medical records, and the Mann-Kendal method was used to estimate the trend of each grade system.Results: A total of 547 patients with SAH were identified. The mean age of the patients was 59.3 years (standard deviation (SD), 14.6). The mean aneurysm size was 6.9 mm (SD, 4.6 mm). The most frequent aneurysm location was the anterior communicating artery (28.7%). In the Mann-Kendal estimates for the analysis of the trend, there was no statistically significant grade throughout the HH and modified Fisher grades. Similarly, there was no improvement throughout all grades in the modified Fisher grade over time. Conclusions:The initial severity of SAH due to cerebral aneurysm rupture did not improve over time.

The pathophysiology of traumatic SDG remains somewhat unclear. This case shows a rare etiology of traumatic SDG and demonstrates the usefulness of CT cisternography to determine cerebrospinal fluid leakage from an implant. CASE REPORTA 68-year-old male patient visited the emergency department after a passerby found him lying on the road with a bicycle. His initial mental status was a stupor mentality