gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

Incidence of cerebral vasosospasm and delayed infarction after perimesencephalic subarachnoid haemorrhage – nonaneurysmal versus perimesencephalic subarachnoid haemorrhage caused by posterior circulation aneurysms

Die Inzidenz von cerebralen Vasospasmen und verzögerten Infarkten nach perimesencepahler subarachnoidaler Blutung: nicht aneurysmatische versus aneurysmatische Blutungen mit perimesencephalem Blutungsmuster

Meeting Abstract

  • presenting/speaker Beate Kranawetter - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Dorothee Mielke - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
  • Vesna Malinova - Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV241

doi: 10.3205/22dgnc233, urn:nbn:de:0183-22dgnc2339

Veröffentlicht: 25. Mai 2022

© 2022 Kranawetter et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objective: Ruptured aneurysms of the posterior circulation may present with a perimesencephalic subarachnoid hemorrhage (PMSAH) pattern similar to nonaneurysmal PMSAH in up to 10% of cases. Although they might look similar on initial CT scans, their clinical course and associated complications, such as cerebral vasospasm and delayed infarction, may vary. The aim of this study was to evaluate if patients with an angiographically negative perimesencephalic SAH were less likely to develop symptomatic vasospasm or delayed infarction than patients with an aneurysmal SAH with perimesencepahlic blood distribution.

Methods: A retrospective analysis of a series of 386 consecutive patients who presented with a spontaneous SAH to our institution between 2009-2020 was performed. All patients fulfilling the definition of a perimesencephalic SAH pattern by Rinkel et al. were included. Overall, 64 patients with a PMSAH were identified, 42/64 (66%) patients presented with a nonaneurysmal PMSAH and 22/64 (34%) with a PMSAH caused by a posterior circulation aneurysm.

Results: The majority of all patients presented with a SAH classified as Hunt&Hess two or below (95%, 61/64), no difference between patients with an aneurysmal and nonaneurysmal PMSAH was seen (p=0.096). Fisher grade, as expected, was low in most patients as well but varied significantly between the two groups (p<0.001). None of the patients with a nonaneurysmal PMSAH developed symptomatic cerebral vasospasm or delayed infarctions, whereby delayed infarction was diagnosed in 5/22 (23%) patients with aneurysmal PMSAH (p=0.003). Out of the 22 patients with a PMSAH caused by a posterior circulation aneurysm, 14% (3/22) developed symptomatic vasospasm and 9% (2/22) had to undergo endovascular spasmolysis.

Conclusion: Our data aligns with the already well-known fact, that nonaneurysmal PMSAH have a benign clinical course with a low rate of adverse events. Aneurysmal PMSAH on the other hand, even if it mimics nonaneurysmal PMSAH in terms of blood amount and distribution on a CT scan, may cause severe complications and should be treated like any other aneurysmal SAH. The reason for the varying clinical course is not clear yet. A theory might be that nonaneurysmal PMSAH may be of venous origin and that the cerebral vessels react differently to venous than to arterial extravasated blood leading to vasospasm and delayed infarction.