Acute subdural hematomas secondary to aneurysmal subarachnoid hemorrhage confer poor prognosis: a national perspective

BackgroundAneurysmal ruptures typically cause subarachnoid bleeding with intraparenchymal and intraventricular extension. However, rare instances of acute aneurysmal ruptures present with concomitant, non-traumatic subdural hemorrhage (SDH). We explored the incidence and difference in outcomes of SDH with aneurysmal subarachnoid hemorrhage (aSAH) as compared with aSAH alone.MethodsRetrospective cohort study from 2012 to 2015 from the National (Nationwide) Inpatient Sample (NIS) (20% stratified sample of all hospitals in the United States). NIS database (2012 to September 2015) queried to identify all patients presenting with aSAH. From this population, the patients with concomitant SDH were identified.ResultsA total of 10 075 patients with both cerebral aneurysms and aSAH were included. Of these, 335 cases of concomitant SDH and aSAH were identified. There was no significant change in the rate of SDH in aSAH over time. SDH with aSAH patients had a mortality of 24% compared with 12% (p=0.003) in the SAH only group, and only 16% were discharged home vs 37% (p=0.003) in the SAH group.ConclusionsThere is a 3.5% incidence of acute SDH in patients presenting with non-traumatic aSAH. Patients with SDH and aSAH have nearly double the mortality, higher rate of discharge to nursing home and rehabilitation, and a significantly lower rate of discharge to home and return to routine functioning. This information is useful in counseling and prognostication of patients with concomitant SDH and aSAH.

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Risk factors for cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage

Open Medicine ◽

10.1515/med-2020-0169 ◽

2020 ◽

Vol 15 (1) ◽

pp. 598-604

Author(s):

Valentina Opancina ◽

Snezana Lukic ◽

Slobodan Jankovic ◽

Radisa Vojinovic ◽

Milan Mijailovic

Keyword(s):

Risk Factors ◽

Subarachnoid Hemorrhage ◽

Cerebral Vasospasm ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Medical Center ◽

White Blood Cells ◽

Cerebral Aneurysms ◽

International Normalized Ratio ◽

Cross Sectional Study ◽

Cross Sectional

AbstractIntroductionAneurysmal subarachnoid hemorrhage is a type of spontaneous hemorrhagic stroke, which is caused by a ruptured cerebral aneurysm. Cerebral vasospasm (CVS) is the most grievous complication of subarachnoid hemorrhage (SAH). The aim of this study was to examine the risk factors that influence the onset of CVS that develops after endovascular coil embolization of a ruptured aneurysm.Materials and methodsThe study was designed as a cross-sectional study. The patients included in the study were 18 or more years of age, admitted within a period of 24 h of symptom onset, diagnosed and treated at a university medical center in Serbia during a 5-year period.ResultsOur study showed that the maximum recorded international normalized ratio (INR) values in patients who were not receiving anticoagulant therapy and the maximum recorded white blood cells (WBCs) were strongly associated with cerebrovascular spasm, increasing its chances 4.4 and 8.4 times with an increase of each integer of the INR value and 1,000 WBCs, respectively.ConclusionsSAH after the rupture of cerebral aneurysms creates an endocranial inflammatory state whose intensity is probably directly related to the occurrence of vasospasm and its adverse consequences.

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Palliative Care Involvement in Patients Hospitalized in the United States with Aneurysmal Subarachnoid Hemorrhage

Journal of Palliative Medicine ◽

10.1089/jpm.2021.0116 ◽

2021 ◽

Author(s):

Ambereen Kurwa Mehta ◽

Scott Mitchell Wright ◽

David Shih Wu ◽

Ché Matthew Harris

Keyword(s):

United States ◽

Palliative Care ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States

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Surgical treatment of intracranial aneurysms: six-year experience in Belo Horizonte, MG, Brazil

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2004000200010 ◽

2004 ◽

Vol 62 (2a) ◽

pp. 245-249 ◽

Cited By ~ 2

Author(s):

Leodante Batista da Costa Jr ◽

Josaphat Vilela de Morais ◽

Agustinho de Andrade ◽

Marcelo Duarte Vilela ◽

Renato P. Campolina Pontes ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Surgical Treatment ◽

Intracranial Aneurysms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

The United States ◽

Anterior Circulation ◽

Common Location ◽

Belo Horizonte ◽

Spontaneous Subarachnoid Hemorrhage ◽

Anterior Circulation Aneurysms

Spontaneous subarachnoid hemorrhage accounts for 5 to 10 % of all strokes, with a worldwide incidence of 10.5 / 100000 person/year, varying in individual reports from 1.1 to 96 /100000 person/year. Angiographic and autopsy studies suggest that between 0.5% and 5% of the population have intracranial aneurysms. Approximately 30000 people suffer aneurysmal subarachnoid hemorrhage in the United States each year, and 60% die or are left permanently disabled. We report our experience in the surgical treatment of intracranial aneurysms in a six year period, in Belo Horizonte, Minas Gerais, Brazil. We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 1997 to January 2003. Four hundred and seventy-seven patients were submitted to 525 craniotomies for treatment of 630 intracranial aneurysms. The majority of patients were female (72.1%) in the fourth or fifth decade of life. Anterior circulation aneurysms were more common (94.4%). The most common location for the aneurysm was the middle cerebral artery bifurcation. The patients were followed by a period from 1 month to 5 years. The outcome was measured by the Glasgow Outcome Scale (GOS). At discharge, 62.1% of the patients were classified as GOS 5, 13.9% as GOS 4, 8.7% as GOS 3, 1.7% as GOS 2 and 14.8% as GOS 1.

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Hypernatremia is associated with poorer outcomes following aneurysmal subarachnoid hemorrhage: a nationwide inpatient sample analysis

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.18.04611-8 ◽

2021 ◽

Vol 65 (5) ◽

Author(s):

Haydn HOFFMAN ◽

Brendon VERHAVE ◽

Lawrence S. CHIN

Keyword(s):

Subarachnoid Hemorrhage ◽

Nationwide Inpatient Sample ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Sample Analysis

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A comparison of 3 radiographic scales for the prediction of delayed ischemia and prognosis following subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns/2008/109/8/0199 ◽

2008 ◽

Vol 109 (2) ◽

pp. 199-207 ◽

Cited By ~ 59

Author(s):

Andreas H. Kramer ◽

Michael Hehir ◽

Bart Nathan ◽

Darryl Gress ◽

Aaron S. Dumont ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Poor Prognosis ◽

Interobserver Variability ◽

Clinical Performance ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Successful Outcome ◽

Multiple Logistic Regression ◽

Regression Analyses ◽

The Relationship

Object Delayed cerebral ischemia is a major cause of morbidity and death following aneurysmal subarachnoid hemorrhage and requires timely intervention for a successful outcome to be achieved. In this study the investigators compared the commonly used Fisher scale with 2 newer radiographic scales for the prediction of vasospasm, delayed infarction, and poor outcome. Methods This was a single-center, retrospective cohort study involving 271 consecutive patients with a ruptured cerebral aneurysm. Without knowledge of subsequent events, admission CT scans were each assigned scores by using 3 different grading schemes: the Fisher, modified Fisher, and Claassen scales. For each of the scales, the relationship between an increasing score and the risk of later complications was assessed in univariate and multiple logistic regression analyses. Results With the Fisher scale, the risk of complications was relatively high when the score was 3, but not for other scores. In contrast, using the other scales, there was a more linear relationship between a rising score and the frequency of complications. This was particularly true for the modified Fisher scale, in which each stepwise increase was associated with an escalating risk of vasospasm, delayed infarction, and poor prognosis. Kappa scores measuring interobserver variability among 4 CT readers were also slightly better with the newer scales. Conclusions Although the modified Fisher and Claassen scales have yet to be prospectively validated, the authors' findings suggest that the clinical performance of these systems is superior to that of the Fisher scale.

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Association of renin-angiotensin system genetic polymorphisms and aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2016.9.jns161593 ◽

2018 ◽

Vol 128 (1) ◽

pp. 86-93 ◽

Cited By ~ 6

Author(s):

Christoph J. Griessenauer ◽

R. Shane Tubbs ◽

Paul M. Foreman ◽

Michelle H. Chua ◽

Nilesh A. Vyas ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Aneurysm ◽

Genetic Polymorphisms ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Renin Angiotensin System ◽

The United States ◽

Dominant Effect ◽

Potential Implication ◽

Angiotensin System ◽

Renin Angiotensin

OBJECTIVERenin-angiotensin system (RAS) genetic polymorphisms are thought to play a role in cerebral aneurysm formation and rupture. The Cerebral Aneurysm Renin-Angiotensin System (CARAS) study prospectively evaluated common RAS polymorphisms and their relation to aneurysmal subarachnoid hemorrhage (aSAH).METHODSThe CARAS study prospectively enrolled aSAH patients and controls at 2 academic centers in the United States. A blood sample was obtained from all patients for genetic evaluation and measurement of plasma angiotensin-converting enzyme (ACE) concentration. Common RAS polymorphisms were detected using 5′ exonuclease (TaqMan) genotyping assays and restriction fragment length polymorphism analysis.RESULTSTwo hundred forty-eight patients were screened, and 149 aSAH patients and 50 controls were available for analysis. There was a recessive effect of the C allele of the angiotensinogen (AGT) C/T single-nucleotide polymorphism (SNP) (OR 1.94, 95% CI 0.912–4.12, p = 0.0853) and a dominant effect of the G allele of the angiotensin II receptor Type 2 (AT2) G/A SNP (OR 2.11, 95% CI 0.972–4.57, p = 0.0590) on aSAH that did not reach statistical significance after adjustment for potential confounders. The ACE level was significantly lower in aSAH patients with the II genotype (17.6 ± 8.0 U/L) as compared with the ID (22.5 ± 12.1 U/L) and DD genotypes (26.6 ± 14.2 U/L) (p = 0.0195).CONCLUSIONSThe AGT C/T and AT2 G/A polymorphisms were not significantly associated with aSAH after controlling for potential confounders. However, a strong trend was identified for a dominant effect of the G allele of the AT2 G/A SNP. Downregulation of the local RAS may contribute to the formation of cerebral aneurysms and subsequent presentation with aSAH. Further studies are required to elucidate the relevant pathophysiology and its potential implication in treatment of patients with aSAH.

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Increasing treatment of ruptured cerebral aneurysms at high-volume centers in the United States

Journal of Neurosurgery ◽

10.3171/2011.7.jns11590 ◽

2011 ◽

Vol 115 (6) ◽

pp. 1179-1183 ◽

Cited By ~ 42

Author(s):

Caleb B. Leake ◽

Waleed Brinjikji ◽

David F. Kallmes ◽

Harry J. Cloft

Keyword(s):

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

High Volume ◽

International Classification Of Diseases ◽

The United States ◽

Ruptured Aneurysms ◽

Patient Admissions ◽

The Us ◽

Classification Of Diseases ◽

Low Volume

Object Evidence of better outcomes in patients with aneurysmal subarachnoid hemorrhage treated at higher-volume centers might be expected to result in more of these patients being referred to such centers. The authors evaluated the US National Inpatient Sample for the years 2001 to 2008 for trends in patient admissions for the treatment of ruptured aneurysms at high- and low-volume centers. Methods The authors determined the number of ruptured aneurysms treated with clipping or coiling annually at low-volume (≤ 20 patients/year) and high-volume (> 20 patients/year) centers and also counted the number of high- and low-volume centers performing each treatment. Hospitalizations for clipping or coiling ruptured aneurysms were identified by cross-matching International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes for the diagnosis of a ruptured aneurysm (ICD-9-CM 430) with procedure codes for clipping (ICD-9-CM 39.51) or coiling (ICD-9-CM 39.52, 39.79, or 39.72) cerebral aneurysms. Results In 2001, 31% (435 of 1392) of the patients who underwent clipping and 0% (0 of 122 patients) of those who underwent coiling did so at high-volume centers, whereas in 2008 these numbers increased to 62% (627 of 1016) and 68% (917 of 1351) of patients, respectively. For clipping procedures, the number of low-volume centers significantly declined from 177 in 2001 to 85 in 2008, whereas the number of high-volume centers remained constant at 13–15. For coiling procedures, the number of low-volume centers decreased from 62 in 2001 to 54 in 2008, whereas the number of high-volume centers substantially increased from 0 in 2001 to 16 in 2005 and remained constant thereafter. Conclusions The treatment of ruptured cerebral aneurysms increasingly occurs at high-volume centers in the US. This trend is favorable given that better outcomes are associated with the treatment of these lesions at high-volume centers.

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ENDOVASCULAR AND SURGICAL TREATMENT OF RUPTURED CEREBRAL ANEURYSMS IN PEDIATRIC PATIENTS

Neurosurgery ◽

10.1227/01.neu.0000327573.42267.cc ◽

2008 ◽

Vol 63 (5) ◽

pp. 859-866 ◽

Cited By ~ 40

Author(s):

Michael F. Stiefel ◽

Gregory G. Heuer ◽

Anuj K. Basil ◽

John B. Weigele ◽

Leslie N. Sutton ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Condition ◽

Pediatric Patients ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Multidisciplinary Treatment ◽

Cerebral Aneurysms ◽

Posterior Circulation ◽

Anterior Circulation ◽

Fisher Grade ◽

Good Clinical Condition

Abstract OBJECTIVE Pediatric cerebral aneurysms are rare. There are very few recent studies that focus on the multidisciplinary treatment of ruptured aneurysms. We reviewed our pediatric endovascular and surgical experience with ruptured cerebral aneurysms. METHODS Pediatric patients aged 16 years and younger who were admitted with a diagnosis of aneurysmal subarachnoid hemorrhage and treated at the Children's Hospital of Philadelphia were included in this analysis. RESULTS Twelve patients with 13 aneurysms (4 male patients and 8 female patients; age range, 4 months–16 years; mean age, 5.1 years), were admitted with subarachnoid hemorrhage during the past 12 years. The majority of patients were admitted in good clinical condition; 31% were in Hunt and Hess Grade II, and 31% were in Hunt and Hess Grade III. The remaining patients were in poor clinical condition and were in Hunt and Hess Grade IV (23%) or Grade V (15%). Computed tomography revealed that 15% of the patients were in Fisher Grade 2, 23% were in Fisher Grade 3, and 62% were in Fisher Grade 4. Endovascular techniques were used in the treatment of 5 aneurysms, and microsurgery was used in the treatment of 8 aneurysms. In the endovascular group, aneurysm sizes ranged from 2 to 35 mm (mean, 12.6 mm); 3 aneurysms were in the anterior circulation, and 2 were in the posterior circulation. In the microsurgery group, 6 aneurysms were in the anterior circulation, and 2 were in the posterior circulation; sizes ranged from 3 to 15 mm (mean, 6.8 mm). Sixty-nine percent of the patients were independent at follow-up. CONCLUSION Contemporary endovascular and microsurgical techniques can be used effectively to treat ruptured cerebral aneurysms in pediatric patients. In the time period studied, the techniques were equally effective when used in the appropriate patients.

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The Natural History of Cerebral Aneurysms

10.1093/med/9780199937837.003.0109 ◽

2017 ◽

Author(s):

David Hasan

Keyword(s):

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Cerebral Aneurysms ◽

Aneurysm Rupture ◽

Morbidity And Mortality ◽

Neurological Dysfunction ◽

Contributing Factors ◽

Intracellular Adhesion Molecule ◽

History Of ◽

Very High

Subarachnoid hemorrhage (SAH) secondary to rupture of cerebral aneurysms represents a relatively small fraction of strokes (5%) but morbidity and mortality associated with aneurysm rupture remain very high despite advances in the treatment of aneurysmal SAH. Cerebral vasospasm (CV) is the leading cause of delayed morbidity and mortality following aneurysmal subarachnoid hemorrhage, as well as delayed neurological dysfunction 1 to 2 weeks after rupture. Endothelial dysfunction is one of the primary contributing factors to CV following aneurysmal SAH, and this is associated with alterations in intracellular adhesion molecule-1 (ICAM-1), matrix metalloproteinases (MM), and the blood-brain barrier[p63].

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