Clinical characteristics of aneurysmal subarachnoid hemorrhage in the elderly over 75; would temporal muscle be a potential prognostic factor as an indicator of sarcopenia?

Introduction: While the thrombotic complications of COVID-19 have been described, there are limited data on its implications in hemorrhagic stroke. The clinical characteristics, underlying stroke mechanism, and outcomes in this group of patients are especially salient as empiric therapeutic anticoagulation becomes increasingly common in the treatment and prevention of thrombotic complications of COVID-19. Methods: We conducted a retrospective cohort study of patients with hemorrhagic stroke (both non-traumatic intracerebral hemorrhage and spontaneous non-aneurysmal subarachnoid hemorrhage) who were hospitalized between 3/1/20-5/15/20 at a NYC hospital system, during the coronavirus pandemic. We compared the demographic and clinical characteristics of patients with hemorrhagic stroke and COVID-19 to those without COVID-19 admitted to our hospital between 3/1/20-5/15/20 (contemporary controls) and 3/1/19-5/15/19 (historical controls), using Fischer’s exact test and non-parametric testing. We adjusted for multiple comparisons using the Bonferroni method. Results: During the study period, 19 out of 4071 (0.5%) patients who were hospitalized with COVID-19 had hemorrhagic stroke on imaging. Of all COVID-19 with hemorrhagic stroke, only 3 had non-aneurysmal SAH without intraparenchymal hemorrhage. Among hemorrhagic stroke and COVID-19 patients, coagulopathy was the most common etiology (73.7%); empiric anticoagulation was started in 89.5% vs 4.2% of contemporary and 10.0% of historical controls (both with p =<0.001). Compared to contemporary and historical controls, COVID-19 patients had higher initial NIHSS scores, INR, PTT and fibrinogen levels. These patients also had higher rates of in-hospital mortality [84.6% vs. 4.6%, p =<0.001]. Sensitivity analyses excluding patients with strictly subarachnoid hemorrhage yielded similar results. Conclusion: We observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in COVID-19 patients occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in COVID-19 patients.

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Aneurysmal Subarachnoid Hemorrhage in the Elderly over Age 75: A Systematic Review

Neurologia medico-chirurgica ◽

10.2176/nmc.ra.2017-0057 ◽

2017 ◽

Vol 57 (11) ◽

pp. 575-583 ◽

Cited By ~ 20

Author(s):

Hiroki OHKUMA ◽

Norihito SHIMAMURA ◽

Masato NARAOKA ◽

Takeshi KATAGAI

Keyword(s):

Systematic Review ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The Elderly

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Clinical characteristics and outcomes of neurogenic stress cadiomyopathy in aneurysmal subarachnoid hemorrhage

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2012.09.006 ◽

2013 ◽

Vol 115 (7) ◽

pp. 909-914 ◽

Cited By ~ 33

Author(s):

Kent J. Kilbourn ◽

Stephanie Levy ◽

Ilene Staff ◽

Inam Kureshi ◽

Louise McCullough

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Characteristics ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Neurogenic Stress

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Treatment Outcome of Aneurysmal Subarachnoid Hemorrhage in Patients Aged 70 Years and Older

Neurosurgery ◽

10.1227/neu.0b013e318207a9fb ◽

2011 ◽

Vol 68 (3) ◽

pp. 753-758 ◽

Cited By ~ 16

Author(s):

Olatilewa O Awe ◽

L Fernando Gonzalez ◽

David Hasan ◽

Mitchell Maltenfort ◽

Robert Rossenwasser ◽

...

Keyword(s):

Treatment Outcome ◽

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Ventriculoperitoneal Shunt ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Statistical Tests ◽

The Elderly ◽

World Federation ◽

Initial Symptom ◽

Initial Symptoms

Abstract BACKGROUND: The incidence of subarachnoid hemorrhage is increasing, especially in the elderly as life expectancy increases. Aggressive treatment of aneurysms in the elderly is usually avoided because of a presumed poor prognosis. OBJECTIVE: The aim of this study was to assess the outcome of treatment in patients older than 70 years old. METHODS: We performed a retrospective chart review of 150 patients aged 70 years and older who were treated at Jefferson Hospital from 2004 to 2009. Data including World Federation of Neurological Surgeons grade and Hunt and Hess classification, specific management components, and treatment outcome on discharge were analyzed. RESULTS: One hundred ten patients had aneurysms coiled, 9 patients had aneurysms clipped, 11 patients had aneurysms that were not treated, and 20 patients had no visible aneurysms. Overall, increased World Federation of Neurological Surgeons grades correlated strongly with poor clinical outcome. Statistical tests indicate that patients who died (mean, 78.8, n = 35) or who went into rehabilitation (mean, 76.5, n = 81) were significantly older than patients who were discharged home (mean, 73.1, n = 20). However, day of presentation after initial symptom(s) of subarachnoid hemorrhage and placement of ventriculoperitoneal shunt also influenced clinical outcome. Patients who had a ventriculoperitoneal shunt were more likely to go into rehabilitation than patients who did not, and patients without a ventriculoperitoneal shunt were more likely to die. CONCLUSION: Older age should not preclude a patient from aneurysm treatment. Factors such as low Hunt and Hess or World Federation of Neurological Surgeons grades, earlier presentation to the hospital after initial symptoms, early shunting, prompt interventions, and tailored postoperative management can result in favorable clinical outcomes.

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