Title:Outcome Prediction after Non-aneurysmal Non-traumatic Subarachnoid Hemorrhage
Volume: 12
Issue: 3
Author(s): Ramazan Jabbarli, Matthias Reinhard, Roland Roelz, Mukesch Shah, Wolf-Dirk Niesen, Klaus Kaier, Christian Taschner, Astrid Weyerbrock and Vera Van Velthoven
Affiliation:
Keywords:
Non-aneurysmal, subarachnoid hemorrhage, outcome, infarction, vasospasm, prediction, risk score.
Abstract: Contrary to aneurysmal bleeding, non-aneurysmal non-traumatic subarachnoid hemorrhage (NASAH) is rarely
associated with unfavorable clinical outcome, cerebral infarction and vasospasm. We aimed to identify independent predictors
for a poor clinical course and outcome after NASAH. All patients with NASAH treated at our institution between
January 2005 and December 2012 were retrospectively analyzed. Collected demographic, clinical and radiographic variables
were divided into primary (admission) and secondary (follow-up) parameters. Independent predictors of unfavorable
outcome (defined as modified Rankin scale=3-6), cerebral infarction and development of vasospasm were identified. In
addition, a risk score for the estimation of clinical outcome was designed. Out of population with 157 NASAH patients,
unfavorable outcome was documented in 57 cases (36.3%) at discharge and in 17 cases (10.8%) after 6 months. Cerebral
infarction(s) were found in 7 patients (4.3%). In multivariate analyses, higher age (≥65 years), poorer initial clinical condition
measured by Hunt & Hess grade and diffuse basal bleeding pattern were independent outcome predictors and therefore
included in the risk score (1-8 points). The risk score correlated with outcome at discharge (p<0.0001) and clinical
improvement after 6 months (p=0.0238). A diffuse basal bleeding pattern predicted the detection of vasospasm by transcranial
Doppler (p=0.001). Poor initial clinical condition (p=0.028) and vasospasm (p=0.031) were associated with the
occurrence of cerebral infarction. NASAH patients with higher age, bad clinical condition on admission and diffuse bleeding
pattern are prone to unfavorable outcome. The proposed risk score helps to identify patients with poor prognosis after
NASAH.
