Artikel
Severe intraventricular hemorrhage strongly predicts early complications and poor outcome after aneurysmal subarachnoid hemorrhage
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Veröffentlicht: | 8. Juni 2016 |
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Objective: Along with subarachnoid hemorrhage (SAH), aneurysm rupture can also cause intraventricular hemorrhage (IVH). In non-SAH cohorts, severe IVH is associated with certain complications and poor outcome. We aimed at identifying the risk factors and clinical impact of severe aneurysmal IVH.
Method: 805 consecutive SAH patients treated at our center between January 2003 and April 2014 were retrospectively analyzed. The severity of IVH was assessed using the original Graeb score upon admission computed tomography scan. The cases with Graeb-score>9 were attributed to severe IVH.
Results: IVH was present in 358 cases (44.5%). Severe IVH was observed in 77 patients (9.6%) and was significantly associated with the rupture of anterior cerebral artery aneurysms (p<0.0001, odds ratio (OR)=2.83), as well as larger aneurysm size (9.6 mm versus 7.1 mm, p= 0.0062). Patients with severe IVH presented frequently with poor initial clinical condition (World Federation Neurosurgical Societies Grade 5, p<0.0001, OR=3.25) and developed complications at the onset of SAH: cerebral infarction (p=0.0048, OR=2.1) and need for decompressive craniectomy (P<0.0001, OR=6.20). Contrarily, delayed complications (symptomatic vasospasm, meningitis and shunt dependency) were not more common for the patients with severe IVH. In-hospital mortality (p<0.0001) and unfavorable outcome at 6 months after SAH (defined as modified Rankin scale>3, p<0.0001) were strongly associated with severe IVH.
Conclusions: Location and size of the ruptured aneurysm are the key risk factors of severe IVH. The clinical impact of severe IVH is attributed to early brain injury with subsequent early complications.