Non-aneurysmal non-traumatic subarachnoid hemorrhage: patient characteristics, clinical outcome and prognostic factors based on a single-center experience in 125 patients

Abstract

BackgroundSubarachnoid hemorrhage (SAH) is mainly caused by ruptured cerebral aneurysms but in up to 15% of patients with SAH no bleeding source could be identified. Our objective was to analyze patient characteristics, clinical outcome and prognostic factors in patients suffering from non-aneurysmal SAH.MethodsFrom 1999 to 2009, data of 125 patients with non-aneurysmal SAH were prospectively entered into a database. All patients underwent repetitive cerebral angiography. Outcome was assessed according to the modified Rankin Scale (mRS) (mRS 0–2 favorable vs. 3–6 unfavorable). Also, patients were divided in two groups according to the distribution of blood in the CT scan (perimesencephalic and non-perimesencephalic SAH).Results106 of the 125 patients were in good WFNS grade (I-III) at admission (85%). Overall, favorable outcome was achieved in 104 of 125 patients (83%). Favorable outcome was associated with younger age (P < 0.001), good admission status (P < 0.0001), and absence of hydrocephalus (P = 0.001).73 of the 125 patients suffered from perimesencephalic SAH, most patients (90%) were in good grade at admission, and 64 achieved favorable outcome.52 of the 125 patients suffered from non-perimesencephalic SAH and 40 were in good grade at admission. Also 40 patients achieved favorable outcome.ConclusionsPatients suffering from non-aneurysmal SAH have better prognosis compared to aneurysm related SAH and poor admission status was the only independent predictor of unfavorable outcome in the multivariate analysis. Patients with a non-perimesencephalic SAH have an increased risk of a worse neurological outcome. These patients should be monitored attentively.

Demographic and clinical features of subarachnoid hemorrhages with and without cerebral aneurysm

“…However, in the literature there are conflicting data about gender distribution. Although non aneurysmal SAH was found to be more common in males (5,11), there are also studies suggesting higher prevalence in females (12,13). Nevertheless gender do not influence the disease severity, similar with our findings.…”

“…The mean age of our patients (58.38±10.91) was similar to that in the current literature (5,9). No significant difference of gender was found between aneurysmal and nonaneurysmal SAHs in our study (10).…”

Increasing numbers of nonaneurysmal subarachnoid hemorrhage in the last 15 years: antithrombotic medication as reason and prognostic factor?

“…2,7,11 More recent data show an increasing number of cases of spontaneous SAH 18,24 as well as nonaneurysmal SAH (NASAH). 15,16 Long-term dipyridamole and warfarin use were associated with an increased risk for aneurysmal SAH (aSAH), whereas the data for low-dose acetylsalicylic acid (LDA) were inconsistent. 10,14,21 Therefore, we analyzed our institutional database for patients suffering from angiography-negative SAH.…”

Admission Neutrophil to Lymphocyte and Platelet to Lymphocyte Ratio as a predictor of mortality in patients with Subarachnoid Hemorrhage

“…It has been previously shown that aneurysmal SAH patients had higher mortality rates and Fisher scores suggesting more severe SAH when compared with nonaneurysmal SAH (24,25). Cerebral aneurysm which is associated with vascular or other factors may worsen the amount of bleeding.…”

“…Turkish Journal of Cerebrovascular Diseases 2018; 24 (1): [19][20][21][22][23][24][25] Comparison of the NLR, PLR and other blood cound parameters of SAH patients with and without cerebral aneurysm has not been studied previously. Therefore, the first aim of this study was to compare these parameters in SAH patients.…”