gms | German Medical Science

60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit den Benelux-Ländern und Bulgarien

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

24. - 27.05.2009, Münster

Lower incidence of vasospasm after aneurysmal subarachnoid haemorrhage in the elderly patient? A prospective clinical series

Meeting Abstract

Suche in Medline nach

  • D. Wachter - Neurochirurgische Klinik, Klinikum der Georg-August-Universität Göttingen
  • V. Rohde - Neurochirurgische Klinik, Klinikum der Georg-August-Universität Göttingen

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocDI.03-09

DOI: 10.3205/09dgnc126, URN: urn:nbn:de:0183-09dgnc1260

Veröffentlicht: 20. Mai 2009

© 2009 Wachter et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Vasospasm is the major cause of morbidity and mortality after aneurysmal subarachnoid haemorrhage (SAH). Anti-vasospastic therapy often is initiated prophylactically to avoid vasospasm-associated delayed ischemic neurological deficits (DIND). However, this therapy also carries risks and has the potential to worsen outcome. Therefore it would be desirable to reserve anti-vasospastic therapy for patients with a substantial risk for the development of vasospasm. It is well known that the vasoreactivity in elderly patients is reduced, but it is not well investigated if the incidence of vasospasm and DIND is lower in elderly patients.

Methods: We analysed a database including 1016 patients, who suffered from SAH. We were able to include 758 patients to this analysis, whose data had been completed regarding the incidence of vasospasm, clinical findings, ischemic findings on CCT-imaging and TCD-results.

Results: 478 patients younger and 280 patients older than 60 years had been identified. 264 patients (55.2%) under the age of 60 yrs. (group 1) and 72 patients (25.7%) older than 60 yrs. (group 2) developed posthaemorrhagic vasospasm. TCD-results revealed mean velocities of 179 cm/sec (group 1) and 154 cm/sec (group 2), respectively. Neurological deficits developed in 26.5% (group 1) and 12.5% (group 2), respectively. CCT-findings showed ischemic lesions in 11.0% (29 patients, group 1) and 5.6% (4 patients, group 2). Clinical outcome according to the GOS-grading-system had been 2.9 versus 2.6, respectively.

Conclusions: Vasospasm is significantly more likely to occur in patients younger than 60 years than in elderly patients. Under physiological circumstances, the basal arteries of the elderly have a lower vasoreactivity. The same seems to hold true in the post-SAH situation. In consequence, focal neurological deficits and ischemic lesions on radiographic imaging more often develop in the younger patient. Possibly, antivasospastic therapy in elderly could be used less aggressively than in younger patients.