gms | German Medical Science

Objective: Contrary to aneurysmal bleeding, non-aneurysmal non-traumatic subarachnoid hemorrhage (NASAH) is rarely complicated with unfavorable clinical outcome, cerebral infarction and vasospasm. We aimed to identify independent predictors for a poor clinical course and outcome after NASAH.

Method: All patients with NASAH treated at our institution between January 2005 and December 2012 were retrospectively analyzed. Demographic, clinical and radiographic variables were divided into primary (admission) and secondary (follow-up) parameters and then separately analyzed. Independent predictors of unfavorable outcome (defined as modified Rankin scale=4-6), cerebral infarction and development of vasospasm were identified. In addition, a risk score for the estimation of clinical outcome was constructed.

Results: 157 patients were eligible. 13 patients (8.3%) had an unfavorable outcome, in computed tomography scans of 7 patients (4.3%) cerebral infarction(s) were found. In multivariate analyses, only higher age (≥65 years), poorer initial clinical condition measured by Hunt&Hess grade and development of severe anemia (hemoglobin <8 g/dL) within two weeks after SAH were independent outcome predictors and therefore included to the risk score (0-13 points). A diffuse aneurysmal bleeding pattern predicted the occurrence of vasospasm on transcranial Doppler (p=0.001). Vasospasm was associated with cerebral infarction (p=0.031) but did not independently predict the outcome. Patients with a high risk score (>9 points) presented in 61.1% of cases with unfavorable outcome (p<0.0001).

Conclusions: NASAH patients with higher age, poorer initial condition and severe anemia are prone to unfavorable outcome. The proposed risk score helps to identify patients with poorer prognosis after NASAH.