Clinical Differences Between Angiographically Negative, Diffuse Subarachnoid Hemorrhage and Perimesencephalic Subarachnoid Hemorrhage

Hui, Ferdinand; Tumialán, Luis M.; Tanaka, Tomoko; Cawley, C. Michael; Zhang, Y. Jonathan

doi:10.1007/s12028-009-9203-2

Cited by 69 publications

(48 citation statements)

References 23 publications

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“…The occurrence of CVS in patients with pmSAH seems to be uncommon, while in patients with non-pmSAH the occurrence CVS has been more frequently described. 4,7 In the current study, symptomatic CVS did not occur in patients with pmSAH, while 2 out of 9 patients with non-pmSAH showed clinically relevant CVS. In the current patient population patients with non-pmSAH had a significantly longer stay in the neurocritical care unit, indicating a generally more complicated clinical course, which is in accordance with previous studies.…”

Section: Discussionmentioning

confidence: 41%

“…In the current patient population patients with non-pmSAH had a significantly longer stay in the neurocritical care unit, indicating a generally more complicated clinical course, which is in accordance with previous studies. 1,2,7 However, concerning the outcome, patients with pmSAH and non-pmSAH had a good overall outcome (GOS 4-5), without any statistical difference. There is an increasing evidence that inflammatory response with cytokines release is related to severity of illness, clinical outcome and occurrence of CVS in patients with SAH.…”

Section: Discussionmentioning

confidence: 92%

“…1,2,5,6 In contrast, patients with non-pmSAH are reported to suffer from a higher risk of a complicated clinical course, development of CVS and subsequent worse outcome. 1, 4,6,7 Inflammatory response with cytokine release is associated with severity of illness, clinical outcome and occurrence of CVS in patients with aSAH. [8][9][10] Higher levels of interleukin (IL)-6 in the cerebro-spinal fluid (CSF) have been linked to the occurrence of CVS and worse outcome.…”

Section: Introductionmentioning

confidence: 99%

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Systemic interleukin-6 concentrations in patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage

Muroi

Bellut

Coluccia

et al. 2011

Journal of Clinical Neuroscience

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Patients with spontaneous non-aneurysmal subarachnoid hemorrhage (non-aSAH) are considered to have a benign illness in contrast to patients with aSAH. The occurrence of the systemic inflammatory response syndrome has been linked to worse outcomes in patients with aSAH. We analyzed systemic interleukin (IL)-6, a proinflammatory cytokine, to determine whether its concentration differs between patients with non-aSAH and those with aSAH, reflecting the more benign illness. Daily systemic IL-6 levels were measured in the acute phase in 11 patients with non-aneurysmal perimesencephalic SAH (pmSAH), with bleeding strictly located around the midbrain, and in nine patients with non-aneurysmal non-perimesencephalic (non-pmSAH), with hemorrhage extending into adjacent cisterns (group 1). IL-6 levels were compared with those from patients suffering from aSAH with cerebral vasospasm (CVS) (group 2) and without CVS (group 3). The mean IL-6 level (±standard error of the mean) was significantly lower in group 1 compared to group 2 (9.9±1.9 vs. 29.1±6.7pg/mL, p=0.018). The difference in mean IL-6 level between group 1 and 3 fell short of significance (9.9±1.9 vs. 14.9±1.1pg/mL, p=0.073). Patients in group 1 had a significantly better outcome (Glasgow Outcome Scale score 4-5) compared to group 2 (p<0.001) and a trend towards better outcome compared to group 3 (p=0.102). A subgroup analysis revealed a higher mean IL-6 concentration in patients with non-pmSAH compared to patients with pm-SAH (p=0.001). We concluded that systemic IL-6 concentration reflects the severity of the inflammatory stress response and course of the illness. The more benign illness and good prognosis of patients with pmSAH or non-pmSAH in contrast to patients with aSAH is reflected by the lower concentrations of IL-6.

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Section: Discussionmentioning

confidence: 41%

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Systemic interleukin-6 concentrations in patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage

Muroi

Bellut

Coluccia

et al. 2011

Journal of Clinical Neuroscience

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“…On the other hand, the high percentage of normal CT (10,4% of ISAH) could be related to the fact that almost one third of them had their diagnostic CT done more than 72 hours after the bleeding episode, and CT sensitivity for SAH diminishes dramatically after 3 days 10 . In general, the reported ISAH series that differentiate blood pattern subtypes on CT, support a higher frequency of the more suspicious aneurysmal pattern than the perimesencephalic one 15,20,21,25,33,38,51,79 . The pmISAH type has been a matter of multiple reports in the literature 50,61,62,69,70 , but many questions are still unsolved, as the origin of the SAH itself from an arterial 37,42,47,59,74 , or a venous source 15,36,41,43,58,70 .…”

Section: Discussionmentioning

confidence: 59%

“…The reported incidence of ISAH in Spain (27,47% in Barcelona 40 , 30,9% in Valencia 48 , 27% in Madrid 33 ), is traditionally higher than in other countries. Managing patients with SAH of unknown origin can be a challenge, because of the uncertainty of their evolution and the lack of evidence about best management measures, but there are few large or multicentre series' reports about ISAH 4,38,20,56,75 . The SENEC Vascular Pathology Group from Spain designed a multicentre data base registry on spontaneous SAH.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

et al. 2010

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SummaryBackground. The Spanish neurosurgical society created a multicentre data base on spontaneous SAH to analyze the real problematic of this disease in our country. This paper focuses on the group of patients with idiopathic SAH (ISAH).Methods. 16 participant hospitals collect their spontaneous SAH cases in a common data base shared in the internet through a secured web page, considering clinical, radiological, evolution and outcome variables. The 220 ISAH cases collected from November 2004 to November 2007 were statistically analyzed as a whole and divided into 3 subgroups depending on the CT blood pattern (aneurysmal, perimesencephalic, or normal).Results. Resultados. Los 220 pacientes con HSAI representan el 19% del total de 1.149 pacientes con HSA recogidos en la base de datos en el mismo periodo.El 46,8% de los casos de HSAI presentaron patrón de sangrado aneurismático en TC, hecho que se correlacionó con mayor edad, peor condición clínica al ingreso, mayor grado Fisher de sangrado, más frecuencia de hidrocefalia y peor evolución, comparados con los casos de HSAI con sangrado en TC del tipo perimesencefálico (42,7%) o con TC normal (10,4%).Una vez superada la fase aguda, e independientemente del tipo de sangrado inicial, la evolución de los pacientes con HSAI es globalmente buena y significativamente mejor que la de los pacientes con HSA aneurismática. La única variable con valor pronóstico en los casos de HSAI, tras realizar un análisis de Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

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Aneurysmal Subarachnoid Hemorrhage

Clarençon¹,

Sourour²,

Degos³

et al. 2016

Neurovascular Imaging

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Clinical Differences Between Angiographically Negative, Diffuse Subarachnoid Hemorrhage and Perimesencephalic Subarachnoid Hemorrhage

Abstract: The angiographically negative d-SAH pattern is associated with worse presentations and outcome. These patients are at increased risk for vasospasm and hydrocephalus requiring aggressive treatment and should therefore be cared for with a higher level of surveillance.

Cited by 69 publications

References 23 publications

Systemic interleukin-6 concentrations in patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage

Systemic interleukin-6 concentrations in patients with perimesencephalic non-aneurysmal subarachnoid hemorrhage

Idiopathic subarachnoid hemorrhage: a multicentre series of 220 patients

Aneurysmal Subarachnoid Hemorrhage

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