Diffuse Patterns of Nonaneurysmal Subarachnoid Hemorrhage Originating from the Basal Cisterns Have Predictable Vasospasm Rates Similar to Aneurysmal Subarachnoid Hemorrhage

Walcott, Brian P.; Stapleton, Christopher J.; Koch, Matthew J.; Ogilvy, Christopher S.

doi:10.1016/j.jstrokecerebrovasdis.2014.11.011

Cited by 19 publications

(11 citation statements)

References 27 publications

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“…1). Of these, 19 were prospective [1, 2, 9, 10, 20, 21, 32, 38, 39, 41–44, 47, 48, 50, 51, 53, 54], 37 were retrospective [4, 6–8, 12–15, 17, 24, 25, 27, 28, 30, 31, 34–36, 40, 57, 58, 61, 63, 66–69, 71–76, 78, 80–82] and two studies [11, 52] had both prospective and retrospective data (Table e-1). Quality assessment results are summarised in Fig.…”

Section: Resultsmentioning

confidence: 99%

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Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

et al. 2019

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BackgroundIn patients with spontaneous subarachnoid haemorrhage (SAH), a vascular cause for the bleed is not always found on initial investigations. This study aimed to systematically evaluate the delayed investigation strategies and clinical outcomes in these cases, often described as “non-aneurysmal” SAH (naSAH).MethodsA systematic review was performed in concordance with the PRISMA checklist. Pooled proportions of primary outcome measures were estimated using a random-effects model.ResultsFifty-eight studies were included (4473 patients). The cohort was split into perimesencephalic naSAH (PnaSAH) (49.9%), non-PnaSAH (44.7%) and radiologically negative SAH identified on lumbar puncture (5.4%). The commonest initial vascular imaging modality was digital subtraction angiography. A vascular abnormality was identified during delayed investigation in 3.9% [95% CI 1.9–6.6]. There was no uniform strategy for the timing or modality of delayed investigations. The pooled proportion of a favourable modified Rankin scale outcome (0–2) at 3–6 months following diagnosis was 92.0% [95% CI 86.0–96.5]. Complications included re-bleeding (3.1% [95% CI 1.5–5.2]), hydrocephalus (16.0% [95% CI 11.2–21.4]), vasospasm (9.6% [95% CI 6.5–13.3]) and seizure (3.5% [95% CI 1.7–5.8]). Stratified by bleeding pattern, we demonstrate a higher rate of delayed diagnoses (13.6% [95% CI 7.4–21.3]), lower proportion of favourable functional outcome (87.2% [95% CI 80.1–92.9]) and higher risk of complications for non-PnaSAH patients.ConclusionThis study highlights the heterogeneity in delayed investigations and outcomes for patients with naSAH, which may be influenced by the initial pattern of bleeding. Further multi-centre prospective studies are required to clarify optimal tailored management strategies for this heterogeneous group of patients.Electronic supplementary materialThe online version of this article (10.1007/s00701-019-04025-w) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Although commonly accepted that patients with naSAH experience a “better” clinical course than aneurysmal SAH patients [23, 76], there is uncertainty regarding the functional outcomes and complications in these patients.…”

Section: Introductionmentioning

confidence: 99%

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

et al. 2019

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“…[ 5 , 8 , 15 ] Angiogram-negative SAH patients have a more favorable and a lower rebleeding rate than aneurysmal SAH patients. [ 5 , 19 ] Thus, some refers angiogram-negative SAH as benign SAH. However, angiogram-negative SAH is heterogeneous and can be divided into perimesencephalic SAH (PSAH) and non-PSAH.…”

Section: Discussionmentioning

confidence: 99%

Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: A case report

Nakajima¹,

Tsuchiya²,

Shimizu³

et al. 2021

Surgical Neurology International

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Background: The causes of angiogram-negative subarachnoid hemorrhage (SAH) on initial angiography, which accounts for 10–30% of spontaneous SAH, are heterogeneous and still unclear. We report a case of nonaneurysmal SAH, in which initial computed tomographic angiography (CTA) showed no source of bleeding, but the subsequent digital subtraction angiography (DSA) revealed contrast extravasation from the basilar artery without aneurysms. Case Description: A 67-year-old woman with a medical history of hypertension presented as SAH of World Federation of Neurological Surgeons Grade II. CTA on admission did not show any cause of bleeding and DSA was subsequently performed to show contrast extravasation from a perforator of the middle third of the basilar artery without aneurysms during the subsequent DSA, resulting in profound deterioration SAH and neurological status. The patient was conservatively treated. Follow-up DSAs on days 2 and 16 showed no source of bleeding as well. Conclusion: Although the precise cause of bleeding in this case is uncertain, SAH might be caused by local dissection of the basilar artery perforator, and the bleeding site might heal spontaneously without forming of a pseudoaneurysm.

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“…According to different backgrounds and clinical conditions, the incidence of hydrocephalus after aSAH ranged from 3.6% to 46.7% [23][24][25][26][27] (Table 1). However, this is not a strict incidence estimate, as the entire population has not been screened.…”

Section: Epidemiology 21 Incidencementioning

confidence: 99%

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

2021

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Hydrocephalus is one of the most common complications of aneurysmal subarachnoid hemorrhage (aSAH), which seriously affects the quality of life and shortens the survival time of affected patients. By reviewing the recent studies on the risk factors of aSAH-associated hydrocephalus, we aimed to explicitly present the pathogenesis of acute and chronic hydrocephalus after aSAH and make a comprehensive list of the associated risk factors of aSAH-associated hydrocephalus and shunt-dependent hydrocephalus. It would help us to better explain the occurrence of hydrocephalus after aSAH, especially hydrocephalus caused by inflammation after bleeding. Many studies have recently suggested that high mobility group box 1 may be an early upstream promoter of inflammatory response after aSAH, which also provides important ideas for us to look for potential drug treatments. The surgery, such as external ventricular drain and lumbar drainage, is the most common and effective treatment. Yet, there are often complications, such as rebleeding and intracranial infection, and the optimal timing of intervention is controversial. Besides, this is also a systematic review of the recent advances in epidemiology, pathogenesis, diagnosis, and management of aSAH-associated hydrocephalus.

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Diffuse Patterns of Nonaneurysmal Subarachnoid Hemorrhage Originating from the Basal Cisterns Have Predictable Vasospasm Rates Similar to Aneurysmal Subarachnoid Hemorrhage

Cited by 19 publications

References 27 publications

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis

Contrast extravasation from basilar artery without aneurysm formation on digital subtraction angiography in computed tomography angiogram-negative subarachnoid hemorrhage: A case report

Hydrocephalus after aneurysmal subarachnoid hemorrhage: Epidemiology, Pathogenesis, Diagnosis, and Management

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