Baseline characteristics and outcome for aneurysmal versus non-aneurysmal subarachnoid hemorrhage: a prospective cohort study

This study aims to investigate the characteristics of patients with mild aneurysmal and non-aneurysmal perimesencephalic and non-perimesencephalic subarachnoid hemorrhage (aSAH, pmSAH, npmSAH) with emphasis on admission biomarkers, clinical course, and outcome. A prospective cohort of 115 patients with aSAH (Hunt and Hess 1–3) and of 35 patients without aneurysms (16 pmSAH and 19 npmSAH) admitted between January 2014 and January 2020 was included. Demographic data, blood samples on admission, complications (hydrocephalus, shunt dependency, delayed cerebral ischemia DCI, DCI-related infarction, and mortality), and outcome after 6 months were analyzed. Demographic data was comparable between all groups except for age (aSAH 55 [48–65] vs. npmSAH 60 [56–68] vs. pmSAH 52 [42–60], p = 0.032) and loss of consciousness (33% vs. 0% vs. 0%, p = 0.0004). Admission biomarkers showed poorer renal function and highest glucose levels for npmSAH patients. Complication rate in npmSAH was high and comparable to that of aSAH patients (hydrocephalus, shunt dependency, DCI, DCI-related infarction, mortality), but nearly absent in patients with pmSAH. Favorable outcome after 6 months was seen in 92.9% of pmSAH, 83.3% of npmSAH, and 62.7% of aSAH (p = 0.0264). In this prospective cohort of SAH patients, npmSAH was associated with a complicated clinical course, comparable to that of patients with aSAH. In contrast, such complications were nearly absent in pmSAH patients, suggesting fundamental differences in the pathophysiology of patients with different types of non-aneurysmal hemorrhage. Our findings underline the importance for a precise terminology according the hemorrhage etiology as a basis for more vigilant management of npmSAH patients. NCT02142166, 05/20/2014, retrospectively registered.

Nontraumatic Nonaneurysmal Subarachnoid Hemorrhage: Risk Factors, Complications, and Clinical Outcomes

Background The present study aimed to investigate the risk factors, complications, and clinical outcomes of patients with nontraumatic, nonaneurysmal subarachnoid hemorrhage (NNSAH). Methods We retrospectively evaluated 78 consecutive patients with NNSAH admitted to our center between April 2009 and April 2019. Patients were divided into two groups based on the distribution of blood in the CT scan, perimesencephalic subarachnoid hemorrhage ( PM-SAH) and nonperimesencephalic subarachnoid hemorrhage (nPM-SAH) groups. The outcome was assessed according to the Glasgow outcome scale (GOS). The demographic data and clinical records including age, sex, smoking history, hypertension, diabetes, history of anticoagulant medication, Glasgow coma score (GCS), Hunt–Hess (HH) grades, and in-hospital complications and clinical outcomes were retrospectively reviewed and compared between the two groups. Results There were 45 patients (57.69%) in the PM-SAH group and 33 cases (42.30%) in the nPM-SAH group with the mean age of 53.98 ± 7.7 years. There were no significant differences between the two groups based on age, sex, smoking history, diabetes, hypertension, anticoagulation medication history, and HH grade at admission. The nPM-SAH group was significantly associated with a higher incidence of radiological and clinical vasospasm (p < 0.05). Moreover, the need for external ventricular drainage (EVD) placement because of the development of hydrocephalus was significantly higher in the nPM group (p < 0.05). Patients with PM-SAH had better clinical outcomes than those with nPM-SAH (p = 0.037). Conclusions Our results showed that patients with nonaneurysmal subarachnoid hemorrhage (NSAH) had favorable clinical outcomes. The PM group had better clinical outcomes and lower complication rates in comparison with the nPM group. Repeated digital subtraction angiography (DSA) examinations are strongly recommended for patients with nPM-SAH.

Analysis of immediate and long-term outcomes of perimesencephalic subarachnoid hemorrhage according to the hospital register data

Introduction. Perimesencephalic subarachnoid hemorrhage (PMSAH) accounts for approximately half of all cases of non-aneurysmal hemorrhage, has a typical pattern on computed tomography (CT) of the brain, and favorable clinical course. Moreover, in the domestic literature there are no studies devoted to this problem.The purpose of the study: to study the frequency of occurrence, clinical and CT features of PMSAH in comparison with nonaneurismatic non-PMSAH according to the hospital register of the regional stroke center.Materials and methods. The data of 383 patients who underwent treatment with a diagnosis of spontaneous SAH in the regional stroke center of Perm Clinical Hospital №4 in 2014–2019 were analyzed. All patients underwent a standard examination, including CT of the brain and digital selective angiography (DSA). According to the pattern of SAH on CT, patients are divided into the groups PM-1 (isolated preptine), PM-2 (traditional) and PM-3 (diffuse). Evaluation of the long-term outcome was carried out using a telephone interview, as well as according to the regional electronic medical system.Results. Of 383 patients with SAH, aneurysms were identified in 350 patients (91,3%). Non-aneurysmal SAH was found in 20 patients (5,2%), in 8 patients (2,1%) − PMSAH. The age of patients averaged 48 years, women predominated. Intense headache in the onset of the disease was observed in the vast majority of patients. Nausea was significantly more often observed in patients with PMSAР (50%) compared with patients with non-PMSAР (8,3%). Loss of consciousness occurred in every fourth patient with PMSAР and only 8% of patients with non-PMSAH. The neurological status of the patients also did not differ and was characterized by a normal consciousness, meningeal syndrome (in 63% of patients with PMSAH) in the absence of focal symptoms. The level of neurological deficit according to NIHSS averaged 0 points, the severity of SAH on the Hunt-Hess scale averaged 2 points. At the time of completion of treatment, most patients did not have a neurological and functional deficit. According to CT, in 4 patients (50%), PM-2 was visualized, in 3 patients (38%) − PM-3, and in one patient − PM-1 (12%). On average, after 15 months, none of the treated patients developed repeated SAH, patients did not have functional limitations.Conclusions. This study for the first time made it possible to characterize the approximate frequency of occurrence, clinical and CT picture, as well as the long-term prognosis of PMSAH in a cohort of patients from a large regional stroke center in Russia.