The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study

Tarkiainen, Jeremias; Hovi, Valtteri; Pyysalo, Liisa; Ronkainen, Antti; Frösen, Juhana

doi:10.1007/s00701-023-05767-4

Cited by 6 publications

(1 citation statement)

References 22 publications

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“…This lesion was thought to be the source of the SAH since the bleeding pattern was typical for a ruptured MCA bifurcation lesion. Moreover, the location and clinical presentation differed from a perimesencephalic SAH [ 23 ]. Besides the ruptured lesion, the patient also presented aneurysm instability during follow-up.…”

Section: Discussionmentioning

confidence: 99%

Stability of infundibular dilatations: a single center follow-up study and systematic review of the literature

Tarkiainen,

Pyysalo,

Hinkka

et al. 2024

Acta Neurochir

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Purpose Although infundibular dilatations (IDs) have been thought to be benign anatomical variants, case reports suggest that they can grow and rupture. The aim of this study was to determine whether IDs have a tendency to grow or rupture. Methods The study population was collected from the Tampere University Hospital (TAUH) Aneurysm Database. The presence of IDs was screened from the medical records and imaging studies of 356 intracranial aneurysm patients left to follow-up from 2005 to 2020. The imaging studies were reviewed to confirm the IDs, and their clinical course. Finally, we performed a systematic review of published cases of ID leading to aneurysmatic rupture from PubMed. Results We found 97 typical IDs in 83 patients and 9 preaneurysmal lesions resembling ID in 9 patients. Out of the typical cone-shaped IDs, none grew or ruptured in a total follow-up of 409 patient-years. One preaneurysmal lesion ruptured during a follow-up: this lesion had components of both infundibular dilatation and aneurysm at the beginning of follow-up. In the systematic literature search, we found 20 cases of aneurysmatic SAHs originating from an ID. Of those, only 7 had imaging available prerupture. All 7 IDs were typically cone-shaped, but a branching vessel originating from the apex of ID was only seen in 4/7. Conclusion Typical infundibular dilatations seem to be benign anatomical variants that are stable and, thus, do not need prophylactic treatment or imaging follow-up. Likely, the SAHs reported from IDs were actually caused by misdiagnosed preaneurysmal lesions.

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Section: Discussionmentioning

confidence: 99%

Stability of infundibular dilatations: a single center follow-up study and systematic review of the literature

Tarkiainen,

Pyysalo,

Hinkka

et al. 2024

Acta Neurochir

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Use of dual intraventricular vasodilators for refractory cerebral vasospasm in a pediatric patient with traumatic subarachnoid hemorrhage: A case report

Javellana,

Asbury,

Kandiah

et al. 2024

American Journal of Health-System Pharmacy

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Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Subarachnoid hemorrhage (SAH) is a rare but life-threatening clinical event for pediatric patients. Cerebral vasospasm is a common complication of SAH that often leads to poor outcomes. This case report describes the use of dual intraventricular (IVT) vasodilators in a pediatric patient. Summary An 11-year-old male presented with traumatic diffuse SAH and cranial vasospasm. Despite treatment with IVT nicardipine, intravenous (IV) milrinone by continuous infusion, enteral nimodipine, and intraarterial verapamil and milrinone given during digital subtraction angiography, transcranial Doppler (TCD) mean velocities continued to rise. IVT milrinone was then added to IVT nicardipine and IV milrinone. The combination of IVT nicardipine, IV milrinone, and rescue therapy with IVT milrinone was continued for a total of 7 days. TCD mean velocities decreased into the mild to moderate range within 2 days of the patient receiving this combined regimen and remained globally low thereafter. Conclusion This case illustrates the potential benefit of using dual IVT vasodilators to improve outcomes for pediatric patients with refractory cerebral vasospasm.

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Functional outcome, return to work and quality of life in patients with non-aneurysmal subarachnoid hemorrhage

Dronkers,

Germans,

Post

et al. 2024

Preprint

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Background: Non-aneurysmal, non-traumatic subarachnoid hemorrhage (nSAH) refers to cases where a causative aneurysm cannot be identified. We studied six-months outcomes in nSAH patients. Methods: From a prospective SAH registry of all nSAH patients admitted between 2012 and 2023, relevant complications and outcomes were collected. Functional outcome and return-to-work at six months were assessed using the modified Rankin Scale (mRS), quality of life with the EuroQol-5Dimensions (EQ-5D) and Hospital Anxiety & Depression Scale (HADS), and an institutional 14-item questionnaire for assessment of residual symptoms. Results: 325 consecutive nSAH patients were included (191 non-perimesencephalic, non-aneurysmal subarachnoid hemorrhage [NPSAH]; 134 perimesencephalic subarachnoid hemorrhage [PMSAH]). 303 (93%; 179 NPSAH and 124 PMSAH) were available at follow-up (7 patients died). Favorable functional outcome (mRS-score 0-2) was reported in 271 (89%) patients and did not differ between NPSAH- and PMSAH. 141 (77%) patients returned to work, whereas only 71 (39%) patients reached their previous level of work. PMSAH patients were more likely to return to work (68/96 (71%) NPSAH and 73/87 (84%) PMSAH, respectively, p=0.01). Furthermore, PMSAH patients were more likely to fully return to work (p=.034). The mean (SD) EQ-5D and EQ-VAS scores were 0.827 (0.184) and 74 (16), respectively. The HADS-A and -D scores were deviant (score >7 points) in 53 (23%) and 48 (21%) patients, respectively. Only 39 patients (16%) denied experiencing residual symptoms. Increased fatigue (n=164; 68%), increased concentration difficulties (n=130; 54%), and increased forgetfulness (n=121; 50%) were the most frequently reported residual symptoms. Conclusions: This study reveals that the majority of nSAH patients reports residual symptoms and did not return to their previous level of work at six months follow-up, despite a favorable functional outcome. These findings nuance the perception of a good outcome, as suggested in previous studies, warranting further research on possible rehabilitative interventions and counseling in these patients.

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The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study

Cited by 6 publications

References 22 publications

Stability of infundibular dilatations: a single center follow-up study and systematic review of the literature

Stability of infundibular dilatations: a single center follow-up study and systematic review of the literature

Use of dual intraventricular vasodilators for refractory cerebral vasospasm in a pediatric patient with traumatic subarachnoid hemorrhage: A case report

Functional outcome, return to work and quality of life in patients with non-aneurysmal subarachnoid hemorrhage

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