gms | German Medical Science

Objective: In general, cerebral vasospasm (CVS) is thought to occur between days 7 and 21 after subarachnoid hemorrhage (SAH). Yet, some patients suffering from SAH have long lasting CVS. The outcome of these patients with a very long treatment on an intensive care unit is unknown. Therefore, we reviewed these patients treated at our center between 2003 and 2012.

Method: Patients with SAH were entered into a prospectively collected database. We retrospectively selected patients with treatment of CVS longer than 15 days after SAH. In all patients, CVS were treated by triple H-therapy. Selected patients were additionally treated by intraarterial nimodipine administration. Outcome was assessed using by the modified Rankin Scale (mRS; favorable (mRS 0-2) and poor (mRS 3-6)) six months after SAH.

Results: Within the selected period, 101 patients were included into this series. The mean of treatment was until day 20, ranged from day 15 to day 42. Of these patients over one third needed a treatment longer than 21 days after SAH. Only 44% of the patients were in a good status at admission (WFNS I–III), 85% had a Fisher type III or IV bleeding and 29% had an intracerebral hematoma (ICH) less than 50 ml. Early hydrocephalus requiring external ventricular drainage was present in 82%. Outcome was favorable in 55%, and 9% of the patients died. In the univariate analysis risk factors for a poor outcome were a poor admission status (odds ratio 3.7, 95% confidence interval 1.6–8.6, p<0.01) and a small ICH (OR 3.4, 95% CI 1.4–8.3, p<0.05). Compared to the data of Conscious-1 (only patients with CVS), the patients in this series were in a worse status at admission (OR 2.5), but preserve a similar outcome. The patient’s sex and age, Fisher grade and the requirement of a decompressive craniotomy/-ectomy were not predictive for outcome. Neither was the method of aneurysm treatment.

Conclusions: The duration of CVS seems not affect the general outcome. Risk factors for a poor outcome in patients with a long lasting CVS were a poor admission status and the presence of a small intracerebral hematoma. Therefore, patients with a small ICH should be observed more sensitive (transcranial doppler) and longer and may need an objective methods (e.g. angiography or perfusion imaging) to validate the reversal of CVS.