gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Medical and neurological complications in perimesencephalic subarachnoid hemorrhage

Meeting Abstract

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  • S. Patek - Klinik für Neurochirurgie, Universitätsklinkum Hamburg-Eppendorf
  • T. Martens - Klinik für Neurochirurgie, Universitätsklinkum Hamburg-Eppendorf
  • M. Westphal - Klinik für Neurochirurgie, Universitätsklinkum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.09.09

DOI: 10.3205/12dgnc243, URN: urn:nbn:de:0183-12dgnc2432

Published: June 4, 2012

© 2012 Patek et al.
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Outline

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Objective: The clinical course of perimesencephalic subarachnoid hemorrhage (SAH) is known as usually benign and long-term outcome is generally better and hospital stay is usually shorter compared to aneurysmal SAH. However, in addition to the effects of the hemorrhage itself, neurological as well as medical complications contribute to the clinical course and outcome.

Methods: 43 patients with perimesencephalic SAH were identified between September 2006 and December 2010 by retrospective chart review. The clinical course, procedures performed, medical and neurological complications as well as follow-up were analyzed.

Results: Among the 43 patients with perimesencephalic SAH, 27 could be classified as Hunt & Hess grade I on admission, 10 cases were grade II and 6 cases were grade III. 15 Patients developed medical or SAH-associated complications. 11 developed hydrocephalus and were treated with external ventricular or lumbar drain. Of these, two developed meningitis and were treated with appropriate antibiotics. Out of the 11 patients with hydrocephalus, 5 patients needed permanent drainage and underwent surgery for a ventriculoperitoneal shunt. This was associated with higher Hunt & Hess grade as no patient with grade I needed either temporary CSF-drainage nor permanent shunting. Two patients developed vasospasm without cerebral ischemia. Two patients needed to be treated with antibiotics due to pneumonia and one suffered from a pleural effusion that required therapy. One suffered from gastritis, probably due to the use of dexamethasone, and another patient developed an aneurysma spurium of the femoral artery as consequence of the performed angiography and therefore had to undergo surgery. The median hospital stay of the patients was 17 days (range: 6–41), the 28 patients without complications had a median stay of 14 days (range: 6–30), while the patients with complications needed hospital treatment for an average of 20 days (range: 13–41). Clinical outcome was good in all patients but one with a median follow-up of 18 months (modified Rankin scale 0–2), however, neurological rehabilitaion was necessary in 93% of the cases due to cognitive deficits.

Conclusions: Perimesencephalic SAH is a benign form of SAH. However, medical and neurological complications occur and are associated with a higher Hunt & Hess grade. Hospital stay is longer due to these complications; therefore, treatment and prevention should not only be focused on neurological, but also on medical complications.