Subarachnoid hemorrhage of unknown origin: prognosis and prognostic factors

Abstract

The cases of 127 consecutive patients with subarachnoid hemorrhage (SAH), in whom cerebral panangiography revealed no cause for the bleeding nor any sign of an intraparenchymatous hemorrhage, were reviewed in a study of the long-term prognosis and the possible prognostic factors in this condition. Data for all 127 patients in the study were obtained, with an average follow-up period of 5.4 years. After the 1st week post-SAH, only three rebleeds had occurred. In all, 80% of the patients had returned to full activity, 91% to at least part-time work; if the patients with hypertension were excluded, these figures rose to 86% and 95%, respectively. Decreased wakefulness on admission related to a slightly poorer prognosis, whereas age and red blood cell count in the cerebrospinal fluid had no prognostic significance. Of those patients who, at the end of the 2nd week following the SAH, were fully awake and had not developed any symptoms of delayed cerebral ischemia (87% of all patients admitted), 88% returned to full activity, 97% to at least part-time work. The survival rate for this group, as well as causes of death, seem to be within the range for normal individuals. It should thus be possible to inform these patients (at least the normotensive ones) of the benignity of their condition, directly after normal angiography. Even among the patients who were able to return to full activity, symptoms attributable to the SAH were common: 22% experienced problems such as frequent headaches, vertigo, irritability, and increased fatigability.

Cerebral vasospasm after subarachnoid haemorrhage of unknown aetiology: A clinical and transcranial Doppler study

“…This is in contrast to our study with 18.8% poor grade patients on admission. The clinical course of patients with SAH of unknown aetiology is generally believed to be benign [6,7,16,19,37,47,52,58,59,62] with a possible satisfactory rate of recovery of 94% [48]. This is also reflected by the long-term results of our patients -except for 2 in whom complications occurred which led to death and to permanent disability, respectively.…”

“…Though considered to be of benign long-term prognosis regarding rebleeding and functional outcome [19,48,52,58,62], there are only few reports about the immediate postictal period of time and about the consecutive occurrence and severity of cerebral vasospasm [65] and delayed ischaemic deficits [11]. In addition not all studies included three-or four-vessel angiography and control angiography in all patients [13,14,16,19,37,61]. A large study refers to a patient population admitted between 1958 and 1980, when contemporary techniques and medications were not yet available [58].…”

The clinical course of perimesencephalic nonaneurysmal subarachnoid hemorrhage

“…However, the site of the blood on CT scan in these 3 patients was different from that in patients with perimesencephalic hemorrhage: only intraventricular blood, or clots in the frontal interhemispheric and left sylvian cisterns, or no blood at all. In other series of nonaneurysmal subarachnoid hemorrhage, with DCI reported in up to 3 1% 1191, the distribution of subarachnoid blood was not mentioned 119-21) or CT scanning was not performed [22). Therefore, the origin of the hemorrhage in these series is uncertain.…”

Subarachnoid hemorrhage without detectable aneurysm. A review of the causes.

“…52 In patients in whom CT scanning suggests a tentorial origin of the hemorrhage and in whom the angiogram seems normal, the angiogram should be reviewed again, with the possibility of a tentorial AVM in mind. If once again no lesion is found, repeat angiography is indicated, including visualization of the external carotid artery because branches of this artery can be the main or the sole feeders.53 Rebleeding may occur in patients with dural AVMs; in a series of 28 patients, 5 presented with subarachnoid hemorrhage, and 3 of these 5 had one or more rebleeds. 54 …”