gms | German Medical Science

Objective: The identification of patients with a high risk for cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is important to initiate appropriate anti-vasospastic therapy. It is well known, that the patient’s age has an influence on the incidence of cerebral vasospasm, where younger patients have a higher risk than elderly patients. Aim of this study was to identify age groups among patients with aSAH with a significant higher risk for developing cerebral vasospasm and to identify a cut off age for a better risk stratification.

Method: We analyzed the incidence of cerebral vasospasm in a patient population of 732 patients with aSAH. 496 patients were female and 257 male. Mean age was 53,3 years (11-86). We defined 6 age groups (<30 years, 30-39, 40-49, 50-59, 60-69 and >70 years). Multivariate linear regression analysis was performed to evaluate the incidence of cerebral vasospasm among the different age groups. ROC analysis was performed to determine a cut off age with the highest positive predictive value for developing cerebral vasospasm, which was defined as an increase of transcranial Doppler sonography values >120cm/s.

Results: The highest risk for the development of cerebral vasospasm after aSAH was found in the patient group between 30-39 years . The risk for cerebral vasospasm decreases significantly in the patient group under 30 years of age in comparison to the group 30-39 years old (p=0.02). Patients older than 60 years of age had a significantly lower risk to develop cerebral vasospasm (60-69 and >70 years). The influence of the patient’s age on the incidence of cerebral vasospasm was independent of the Fisher grade in this series. The cut off age with the highest positive predictive value for developing cerebral vasospasm was 38 years of age (ROC, PPV 65%). The incidence of cerebral vasospasm was statistically significant higher in female than in male patients (p=0.02).

Conclusions: The incidence of cerebral vasospasm after aSAH is age and sex dependent. In patients with the highest risk for developing cerebral vasospasm a continuos neurological monitoring as well as early initiation of further diagnositic and therapeutic interventions should be performed. In elderly patients with a significantly lower risk for cerebral vasospasm, the application of antivasospastic therapy carrying the potential to worsen the patients outcome should be initiated more restrictive.