Artikel
Short- and long-term outcome after non-aneurysmal subarachnoid hemorrhage
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Autoren
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Jürgen Konczalla
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt/Main
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Daniel Schmitz
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt/Main
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Sepide Kashefiolasl
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt/Main
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Christian Senft
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt/Main
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Volker Seifert
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt/Main
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Johannes Platz.
- Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe-Universität, Frankfurt/Main
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
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Objective: In up to 15% of patients with subarachnoid hemorrhage (SAH) a bleeding source can't be identified, and especially perimesencephalic (PM) SAH is assumed to have an excellent outcome. Our objective was to analyze the long-term physical and psychological outcome of patients after non-aneurysmal SAH.
Method: Between 1999 and 2012 173 patients met the inclusion criteria. All patients underwent repetitive cerebral angiography. Short-term follow-up (F/U) six months after SAH was assessed according to the modified Rankin Scale (mRS: 0-2 favorable vs. 3-6 unfavorable). A short-form health survey with 36 questions (SF-36) and eight scales were used as questionnaire. Also, patients were divided into different subgroups – non-perimesencephalic (NPM), PM, Fisher 3 blood pattern, mRS 0.
Results: We received 37 answers from both groups, PM- and NPM-SAH. We received answers on average 76.1 months after ictus (range 18 - 168 months). The mean age at ictus was 56 ± 12 years. The quality of life (QoL) is significant reduced after non-aneurysmal SAH compared to the standard population. The patient characteristics and outcome of the PM- and NPM-SAH groups at short- and long-term F/U are similar, but reduced for the most scales in NPM-SAH. Especially patients with a Fisher 3 blood pattern had significant higher risks for unfavorable outcome, reduced QoL and mortality in short- and long-term F/U. The mRS0-group with excellent short-term outcome had a similar QoL at long-term F/U like standard population (except role limitations because of physical health problems (rolph)).
Conclusions: Patients with PM-SAH and NPM-SAH have a decreased QoL in the long-term F/U and only the mRS 0-group (except rolph) have a similar QoL compared to the standard population. Perimesencephalic and non-perimesencephalic SAH without Fisher 3 have excellent short-term outcomes. The Fisher 3 blood pattern-group had a significantly worse clinical outcome, at short- and long-term F/U. Therefore we advise to stratify the NPM-SAH into patients with Fisher 3 blood pattern and without Fisher 3 blood pattern in further investigations.
