gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Are patients with an additional intracerebral hematoma after subarachnoid hemorrhage at a higher risk for delayed cerebral vasospasm?

Meeting Abstract

  • Johannes Platz - Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe Universität Frankfurt
  • Markus Bruder - Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe Universität Frankfurt
  • Christian Senft - Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe Universität Frankfurt
  • Volker Seifert - Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe Universität Frankfurt
  • Jürgen Konczalla - Klinik und Poliklinik für Neurochirurgie, Johann Wolfgang Goethe Universität Frankfurt

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocMI.11.03

doi: 10.3205/13dgnc368, urn:nbn:de:0183-13dgnc3683

Published: May 21, 2013

© 2013 Platz et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Cerebral vasospasm (CVS) and delayed ischemic deficits (DID) have a major impact on the outcome of patients suffering from aneurysmal subarachnoid hemorrhage (SAH). The goal of this study was to assess the influence of an additional SAH-associated intracerebral hematoma (ICH) on the occurrence of CVS and DID.

Method: Retrospective analysis of 587 SAH-patients treated at our center between 2006 and 2011. Patients who died early after SAH without the occurrence of CVS were excluded from the analysis as were patients who were transferred to another hospital within the first 14 days after SAH.

Results: ICH was documented in 135 of 587 patients. It was located within the frontal lobe in 78, temporal lobe in 27 and around the Sylvian fissure in 30 patients. ICH was most often observed in patients with aneurysms of the middle cerebral artery (n=45 of 108 patients, 41.7%, p<0.001). Fifty-nine patients were excluded from the analysis. In the remaining 528 patients, delayed angiographic CVS occurred in 281 patients (53.2%) and DID were documented in 191 of the patients (36.2%). CVS was observed more often in patients with than without ICH (28.1% and 15.0%, respectively, p<0.001, OR 2.22), as were DID (29.3% vs. 17.8% in patients with and without ICH, p=0.002, OR 1.92). CVS occurred most often in patients with a perisylvian ICH (76.0%) compared to the presence of a frontal (69.6%), temporal (54.5%), or no ICH (49.0%, p=0.001). Similar results were found for the occurrence of DID (p=0.018). In a multivariate model, the presence of ICH was the one of the strongest predictors for the occurrence of CVS (p=0.033, OR 1.68). Furthermore, the presence of early hydrocephalus (p<0.001, OR 2.28), the patient’s sex (p=0.037, OR 1.52), admission status as scored by Hunt & Hess (p=0.044, OR 1.20), and method of aneurysm treatment (p=0.027, OR 0.95) were predictive for the occurrence of CVS, whereas age, aneurysm location and size, as well as Fisher grade and location of the ICH were not.

Conclusions: The presence of ICH was associated with an increased risk for delayed CVS after SAH and may present an additional risk factor for the occurrence of DID. Therefore, a modification of the Fisher scale may seem reasonable.