gms | German Medical Science

65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

11. - 14. Mai 2014, Dresden

Clinical outcome of patients after a recurrent delayed subarachnoid hemorrhage – same prognosis as after first subarachnoid hemorrhage?

Meeting Abstract

  • Jürgen Konczalla - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main
  • Erdem Güresir - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main
  • Patrick Schuss - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main
  • Christian Senft - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main
  • Volker Seifert - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main
  • Johannes Platz - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt, Frankfurt am Main

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMI.18.04

doi: 10.3205/14dgnc381, urn:nbn:de:0183-14dgnc3813

Veröffentlicht: 13. Mai 2014

© 2014 Konczalla 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: 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.