Pattern Not Volume of Bleeding Predicts Angiographic Vasospasm in Nonaneurysmal Subarachnoid Hemorrhage

Raya, Amanda; Zipfel, Gregory J.; Diringer, Michael N.; Dacey, Ralph G.; Derdeyn, Colin P.; Rich, Keith M.; Chicoine, Michael R.; Dhar, Rajat

doi:10.1161/strokeaha.113.002629

Cited by 24 publications

(17 citation statements)

References 15 publications

(22 reference statements)

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“…In other words, it may be that there is not anything inherent to the pathophysiology of diffuse pattern bleeding that leads to a higher incidence of hydrocephalus, aside from the effects of greater blood volume. This is in contrast to our prior work in vasospasm and NA-SAH, which demonstrated that pattern was an independent predictor of angiographic vasospasm, even when accounting for blood burden [10]. Interestingly, when we evaluated the progression of acute to chronic hydrocephalus, we found that diffuse bleeding pattern did remain an independent predictor of shunting.…”

Section: Discussioncontrasting

confidence: 99%

“…In contrast to aneurysmal SAH, it is thought that NA-SAH represents a more benign entity with less morbidity and mortality, especially in the context of a perimesencephalic SAH (PM-SAH) pattern of bleeding [2][3][4][5][6]. Recent studies, however, have questioned whether risk of complications such as vasospasm or hydrocephalus after NA-SAH is actually minimal, especially for those with a diffuse, aneurysmal-like pattern of bleeding [7][8][9][10]. It remains unclear whether this variability in clinical course is explained by differing pathophysiologic processes underlying these two types of bleeding, or simply mediated by the fact that those with diffuse bleeding tend to harbor more cisternal and intraventricular blood.…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Acute and Chronic Hydrocephalus in Nonaneurysmal Subarachnoid Hemorrhage

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factors Associated with Acute and Chronic Hydrocephalus in Nonaneurysmal Subarachnoid Hemorrhage

et al. 2015

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“…Kramer et al (12) found that the clinical performance of the modified scale is better. Hijdra et al (8) developed a more comprehensive grading scale that is superior to the modified (16). Although due to the earlier time period of the data collection we could not test the newer scales, our results support the necessity of reevaluation of the original Fisher grading scale.…”

Section: Amount and Location Of Bloodmentioning

confidence: 52%

Predictors of symptomatic vasospasm after subarachnoid hemorrhage: a single center study of 457 consecutive cases

Kozák

Bereczki²,

Szabó³

2015

Turkish Neurosurgery

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400 consecutive patients with SAH in a single neurosurgical center in Eastern Hungary. █ MATERIAL and METHODS Patient PopulationDebrecen is the second largest city in Hungary. It is located in the Eastern part of the country. Data of primary SAH patients admitted or referred to the Department of Neurosurgery at the University of Debrecen between the 1 st of January 1987 and the 31 st of December 2004 were collected prospectively and entered in an anonymized database. Because University of Debrecen is a referring center of the region, patients are registered not only from Debrecen City, but also from several counties of the region with a catchment area of approximately 700 000 inhabitants. SAH was determined by clinical symptoms and neuroimaging findings (CT, angiography). Lumbar █ INTRODUCTION Subarachnoid hemorrhage (SAH) accounts for a minority of all stroke cases but its impact is severe as it strikes at a fairly young age and it is associated with high case fatality and disease burden. After the hemorrhage itself vasospasm is the leading cause of death and disability in SAH patients (14). Angiographic vasospasm develops in up to 70% of the patients, whereas symptomatic vasospasm in 20 to 30% of the cases (7). Several factors were proposed as predictors of vasospasm, such as age, sex, amount of blood on computed tomography (CT) (Fisher grade or other method), admission status etc. Results of these studies are controversial. Furthermore there are significant differences in definitions and methods used in these studies.The aim of the present study was to identify predictors of symptomatic vasospasm in a prospective database of over AIM: We set forth to identify predictors of symptomatic vasospasm in patients with subarachnoid hemorrhage (SAH). MATERIAL and METHODS:We used multivariate logistic regression analysis of the prospective, hospital based, single center register of the Department of Neurosurgery, University of Debrecen, Hungary.Evaluated patients' characteristics were: sex, age, Hunt-Hess grade on admission, location of aneurysm, thickness of blood clot on initial CT scan (Fisher grade), hypertension. RESULTS:Between 1987 and 2004, 567 SAH cases were registered, 457 were included in this study. Symptomatic vasospasm developed in 22.5% of the cases. In univariate analysis, Hunt-Hess grades 2 and 3 and female sex were predictive for symptomatic vasospasm. In multivariate analysis, female sex remained a significant predictor: OR: 1.8 (1.005-3.2). CONCLUSION:Women are at more danger of developing symptomatic vasospasm after subarachnoid hemorrhage.

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“…49 The isolated perimesencephalic pattern has a better prognosis than other subtypes of SAH, with hydrocephalus and symptomatic vasospasm being decidedly uncommon on follow-up. 45,50 Although the cause of pSAH remains elusive, multiple studies have suggested a venous origin for a majority of pSAH cases. Because 10% of posterior circulation aneurysms present with a perimesencephalic bleeding pattern, some angiographic imaging is essential, but the use of additional angiographic studies is debated.…”

Section: Discussionmentioning

confidence: 99%

“…Vasospasm and hydrocephalus are infrequent with pSAH. 45,50 Given the excellent sensitivity and the noninvasive nature of CTA, repeat imaging may be performed preferentially using CTA. 74 by guest on May 9, 2018 http://stroke.ahajournals.org/ Downloaded from…”

Section: Discussionmentioning

confidence: 99%

Use of Follow-Up Imaging in Isolated Perimesencephalic Subarachnoid Hemorrhage

Kalra

Matouk

et al. 2015

Stroke

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A retrospective keyword search was performed for reports containing the words perimesencephalic, prepontine, or pretruncal in the past 6 years at our single, large, multisite, academic institution after obtaining Institutional Review Board approval with waiver of consent. Inclusion criteria consisted of patients with perimesencephalic pattern of blood on initial noncontrast CT undergoing CTA and DSA within 24 hours of admission and additional follow-up angiographic imaging. Patients with history of trauma, diffuse SAH, thick blood above the perimesencephalic cistern, and intraventricular blood were excluded. Two-hundred fourteen CTA reports met keyword search Background and Purpose-Multiple studies have shown that negative computed tomographic angiograms (CTAs) are reliable in excluding aneurysms in patients with isolated perimesencephalic subarachnoid hemorrhage (pSAH). We evaluate the use of digital subtraction angiography versus CTA for initial diagnosis and of angiographic follow-ups in patients with pSAH by performing an institutional analysis and a meta-analysis of literature. Methods-Retrospective institutional analysis of patients with pSAH was performed from 2008 to 2014. The number and types of follow-up imaging studies were tabulated. Initial and follow-up studies were evaluated by an experienced neuroradiologist for intracranial aneurysm. Meta-analysis of literature was performed to assess the use of initial digital subtraction angiography and of follow-up imaging. Results-Our institutional review revealed no additional use of initial digital subtraction angiography or of any angiographic follow-up after initial negative CTA in patients with pSAH on noncontrast CT. Meta-analysis of 40 studies yielded a total of 1031 patients. Only 8 aneurysms were first diagnosed on follow-ups (0.78%). Careful review showed that some of these aneurysms reported on follow-up are of questionable validity. Initial digital subtraction angiography and follow-up imaging after a negative initial CTA showed no statistically significant benefits. Conclusions-In

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Pattern Not Volume of Bleeding Predicts Angiographic Vasospasm in Nonaneurysmal Subarachnoid Hemorrhage

Cited by 24 publications

References 15 publications

Factors Associated with Acute and Chronic Hydrocephalus in Nonaneurysmal Subarachnoid Hemorrhage

Factors Associated with Acute and Chronic Hydrocephalus in Nonaneurysmal Subarachnoid Hemorrhage

Predictors of symptomatic vasospasm after subarachnoid hemorrhage: a single center study of 457 consecutive cases

Use of Follow-Up Imaging in Isolated Perimesencephalic Subarachnoid Hemorrhage

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