Artikel
Warning headache as the main risk factor for early rebleeding after subarachnoid hemorrhage
Risikofaktoren für eine frühe Reblutung nach SAB
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Autoren
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J. Beck
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
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A. Raabe
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
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M. Setzer
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
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H. Vatter
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
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R. Gerlach
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
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V. Seifert
- Klinik für Neurochirurgie, Universitätsklinikum Frankfurt/Main
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: To find predictors for early rebleeding after subarachnoid hemorrhage (SAH).
Methods: Data of 305 consecutive patients with SAH/aneurysms were prospectively recorded in a SPSS database. Age, gender, smoking status, clinical grade according to Hunt&Hess, the presence of a warning headache (WH) in the 4 weeks prior to the index SAH, the amount of blood on initial CT according to Fisher, presence of ventricular drainage and time to aneurysm obliteration were analyzed. Rebleeding was confirmed by evidence of recurrent hemorrhage on CT in all cases. Outcome was assessed at 6 months according to the modified Rankin scale.
Results: Rebleeding occurred in 23 (9.7%) of the 237 consecutive patients with SAH. Of all patients 41 (17.3%) had had a warning headache. Patients with a warning headache had an almost 7-fold (RR=6.8) higher risk of in-hospital rebleeding compared to patients without a warning headache (P<0.001, confirmed by multivariate analysis: P<0.001). Aneurysms that rebleed were significantly larger (P=0.0021). There was a trend for an increased risk for rebleeding for H&H grade (P=0.12), posterior aneurysm-location (P=0.14), and Fisher grade 3 (P=0.25). Not related to early rebleeding were smoking (P=0.42), CSF-drainage (P=0.51), gender (P=0.51), age (P=0.62), and time to aneurysm obliteration (P=0.96). Patients with a rebleeding had a significantly worse outcome after 6 months (3.0 vs 4.32 on mRS, P=0.01).
Conclusions: Size as a known risk factor for rebleeding was confirmed. There was also a trend for higher H&H and Fisher grades, as well as for the location in the posterior circulation. However,we noted that the presence of a warning headache (WH) was the strongest predictor for early rebleeding. Patients with SAH who had a warning headache constitute a special group of patients with a 7-fold risk for early rebleeding compared to patients without a warning headache. The presence of a warning headache can select candidates for ultra early aneurysm treatment.
