Nonaneurysmal nonperimesencephalic subarachnoid hemorrhage: is it a benign entity?

Gupta, Sunil; Gupta, Rahul; Khosla, Virender K.; Mohindra, Sandeep; Chhabra, Rajesh; Khandelwal, Niranjan; Gupta, V.; Mukherjee, Kanchan Kumar; Tewari, Manoj Kumar; Pathak, Ashish; Mathuriya, S. N.

doi:10.1016/j.surneu.2008.04.021

Cited by 59 publications

(63 citation statements)

References 22 publications

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“…Patients with NNSAH tend to be male, younger and less hypertensive compared with those with aneurysmal SAH according to the current literature (6,13,23,42,52). The agerelated epidemiological data of our study cohort was in line with that of existing literature (mean age of 51 years); however, our study found no gender predominancy (51% to 49%).…”

Section: █ Resultssupporting

confidence: 88%

“…Among these bleeding patterns, pure perimesencephalic (PM) SAH is associated with lower complication rates, mild clinical course and better outcomes (3,4,23). PM-SAH was first defined by van Gijn et al (55), and approximately one third to two thirds of these patients were reported to have this bleeding pattern (18,23,29).…”

mentioning

confidence: 99%

“…The remainder of the patients had different bleeding patterns on the initial CT scans, including sylvian, intraventricular, interhemispheric or convexal patterns. All of these bleeding patterns may be designated as nonperimesencephalic (nPM) SAH, and both the clinical course as well as the outcome of patients with nPM-SAH remains controversial (6,23,57).…”

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confidence: 99%

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Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature

Akçakaya

Aydöseli²,

Aras³

et al. 2016

Turkish Neurosurgery

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ABSTRACTof patients with non-traumatic subarachnoid hemorrhage, no underlying cause was detected on initial four to six vessel digital subtraction angiography (DSA) (13,21,31,48,52,54).Although the clinical course of non-traumatic non-aneurysmal subarachnoid hemorrhage (NNSAH) has been reported to be █ INTRODUCTION T he majority of non-traumatic subarachnoid hemorrhage (SAH) events are caused by the rupture of saccular aneurysms, which are associated with significant morbidity and mortality (16). However, in approximately 15% AIM: To report our experience with a relatively large series of patients with non-traumatic non-aneurysmal subarachnoid hemorrhage (NNSAH) to identify the prognosis associated with different bleeding patterns as well as a further diagnostic work-up to determine the underlying cause. MATERIAL and METHODS:Between January 2004 and December 2014, 81 patients with angiography-negative non-traumatic subarachnoid hemorrhage (SAH) were treated at our institution. Diagnosis was confirmed with a typical history of spontaneous SAH and cranial computed tomography (CT) scan or lumbar puncture (LP). The patients were grouped according to the bleeding pattern on the CT scan: Group 1: Perimesencephalic (PM) SAH (n=33, 40.7%); Group 2: Non-perimesencephalic (nPM) SAH (n=41, 50.6%); and Group 3: CT-negative NNSAH (n=7, 8.6%). The clinical course, hospitalization period, and complications were noted. All patients underwent an initial four-vessel digital subtraction angiography (DSA). Cranial magnetic resonance imaging (MRI), repeat DSA investigations and spinal MRI were performed in all patients. RESULTS:The mean hospital stays were 6.3, 14.7 and 10.1 days for patient groups 1, 2, and 3, respectively. The mortality rate was 1.2% (1 patient) in our series. Repeat DSA investigations were positive in two patients (2.5%), both from Group 2 (4.9%). Cranial MRI revealed 100% negative results. Spinal MRI revealed positive results in three patients from Group 2 (7.3%). CONCLUSION:We suggest our diagnostic work-up for patients with nPM-SAH, namely repeat DSA and spinal MRI, until an evidence-based guideline is established for the patient management.

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Section: █ Resultssupporting

confidence: 88%

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confidence: 99%

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Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature

Akçakaya

Aydöseli²,

Aras³

et al. 2016

Turkish Neurosurgery

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“…The risk of rebleeding and especially the risk of developing cerebral vasospasm (CVS) seem to be negligible. 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.…”

Section: Introductionmentioning

confidence: 99%

“…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%

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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Perimesencephalic Subarachnoid Hemorrhage: Risk Factors, Clinical Presentations, and Outcome

Kong

Zhang

Qin

2011

Early Brain Injury or Cerebral Vasospasm

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Nonaneurysmal nonperimesencephalic subarachnoid hemorrhage: is it a benign entity?

Cited by 59 publications

References 22 publications

Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature

Clinical course of nontraumatic nonaneurysmal subarachnoid hemorrhage: a single institution experience over 10 years and review of the contemporary literature

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

Perimesencephalic Subarachnoid Hemorrhage: Risk Factors, Clinical Presentations, and Outcome

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