Artikel
Clinical outcome of patients after a recurrent delayed subarachnoid hemorrhage – same prognosis as after first subarachnoid hemorrhage?
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Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: Patients suffering from a delayed recurrent subarachnoid hemorrhage (SAH) after aneurysm treatment are rare. Therefore, we analyzed patient characteristics, aneurysm characteristics, clinical outcome and prognostic factors of patients suffering from a second aneurysmal SAH years after their first treated SAH. We also compared the outcome from patients with a recurrent SAH to the outcome of patients after the initial aneurysmal SAH (ISAT data).
Method: From 1999 to 2011, 14 of 1036 (1.35%) patients suffered from a second SAH, delayed after the first aneurysmal SAH treated with securing of the aneurysm. Clinical and radiological characteristics were entered into a prospectively conducted database. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months (mRS Score 0-2 favourable vs. 3-6 unfavourable).
Results: Delayed SAH occurred at a mean interval of 130 months after surgical treatment and 74 months after endovascular treatment, respectively, with an overall mean interval of 110 months. In 5 cases, a re-rupture of the formerly secured aneurysm was found and in 3 patients, a de novo aneurysm very close to the formerly treated one was found. The earliest event of a second SAH was after 35 months in a patient with a previously coiled basilar aneurysm and a newly detected aneurysm of the middle cerebral artery (clipped). At the delayed SAH 8 of 14 patients presented in WFNS grade I-III at admission (57.1%). Overall, favourable outcome was achieved in 5 patients only (35.7%). 3 patients died (21.4%), whereas one of these patients died before treatment. Favourable outcome seems to be associated with younger age (46 vs. 61 years, p<0.05). Compared to patients with initial SAH (ISAT data), the admission status at the second SAH is worse (62% WFNS grade I-III vs. 94% from ISAT-data, p<0.0001). Also, only 38% of the patients achieved a good outcome after second SAH compared to 73% patients after first SAH (p<0.01).
Conclusions: Patients with a delayed second SAH had a worse prognosis compared to patients with a first SAH (ISAT data), but the patients can also achieve an excellent outcome (2 patients with mRS 0 and 2 patients with mRS 1). The present data also suggest that age is a prognostic factor for outcome.