• Abdul Rashid Bhat, Mohammed Afzalwani, and Altaf R Kirmani.
• Department of Neurosurgery, Sher i Kashmir Institute of Medical sciences (SKIMS), Srinagar, Kashmir, India.
• Asian J Neurosurg. 2011 Jul 1; 6 (2): 57-71.

ContextKashmir, a snow bound and mountain locked valley, is populated by about 7 million ethnic and non-migratory Kashmiris who have specific dietary and social habits than rest of the world. The neurological disorders are common in Kashmiri population.AimsTo study the prevalence and outcome of spontaneous intracranial subarachnoid hemorrhage (SAH) in Kashmir compared withother parts of the world.Settings And DesignA retrospective and hospital based study from 1982 to 2010 in the single and only Neurosurgical Centre of the State of Jammu and Kashmir.Materials And MethodsA hospital based study, in which, information concerning all Kashmiri patients was collected from the case sheets, patient files, discharge certificates, death certificates, and telephonic conversations with the help of Medical Records Department and Central Admission Register of Sher-i-Kashmir Institute of Medical Sciences, Kashmir India.Statistical AnalysisAnalysis of variance and students T-test were used at occasions.ResultsIncidence of SAH in Kashmiris is about 13/100,000 persons per year. SAH comprises 31.02% of total strokes and aneurysmal ruptures are cause of 54.35% SAHs. The female suffers 1.78 times more than the male. Total mortality of 36.60% was recorded against a good recovery of 14.99%. The familial SAHs and multiple aneurysms were also common. Intra-operative finding of larger aneurysmal size than recorded on pre-operative computed tomography (CT) angiogram of same patients was noteworthy. In 493 patients of SAH, the angiography revealed 705 aneurysms.ConclusionSpontaneous intracranial subarachnoid hemorrhage, due to aneurysmal rupture, is common in Kashmir, with worst outcome. Food habits like "salt-tea twice a day", group-smoking of wet tobacco like "Jejeer", winter season, female gender, hypertension, and inhalation of "Kangri" smoke are special risk factorsof SAH, in Kashmiris. The plain CT brain and CT angiography are best diagnostic tools. The preventive measures for aneurysmal formation and rupture seems most promising management of future. The detachable endovascular aneurysmal occupying video assisted micro-camera capsules or plugs may be future treatment.

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