Spontaneous Angiogram Negative Subarachnoid Hemorrhage : A Retrospective Single Center Cohort Study

Abstract

Background: Spontaneous angiogram negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications and outcome of patients with angiogram negative SAH.

Methods: We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004–2018 due to spontaneous angiogram negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale at three months. We assessed factors that associated with outcome using multivariable logistic regression analysis.

Results: Of included 108 patients, 84% had a favorable outcome and mortality was 5% within oneyear. Median age was 58 years, 51% were female, and 93% had a low grade SAH (World Federation of Neurosurgical Societies grading I-III). The median number of angiograms performed per patient was two. Thirty per cent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio 4.05, 95% confidence interval 1.05–15.73). Two patients had a new bleeding episode. One of those patients had already suffered a spontaneous angiogram negative SAH prior to the current hospitalization.

Conclusion: SAH-related complications such as hydrocephalus and vasospasm are common after angiogram negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. Our findings stress the importance of specialized neurointensive care for these patients.

Spontan angiografi negativ subaraknoidalblödning (SAB) betraktas som en benign sjukdom, i synnerhet jämfört med aneurysmatisk SAB. Vi framställer den kliniska bilden, komplikationer och utfall hos patienter med angiografi negativ SAB i denna retrospektiva studie.

Vi granskade alla patienter som antogs till den neurokirurgiska intensivvårdsavdelningen vid Tölö sjukhus för spontan angiografi negativ SAB under åren 2004-2018. Vårt primära utfall var Glasgow Outcome Scale efter tre månader, kategoriserat i två grupper. Vi bedömde faktorer som korrelerade med utfallet genom multivariat logistisk regressionsanalys.

Totalt 108 patienter inkluderades i studien. 84% hade ett positivt utfall och 5% avled inom ett år. Medianåldern för patienterna var 58 år, 51% var kvinnor och 93% hade en lindrig SAB. Medianantalet utförda angiografier var två per patient. Trettio procent led av akut hydrocefalus, 28% behandlades med ventrikeldränage och 17% erhöll en permanent shunt. 13% behandlades för vasospasm. Endast akut hydrocefalus korrelerade med negativt utfall i den logistiska regressionsmodellen. Två patienter led av re-blödning.

Slutsatsen är att hydrocefalus och vasospasm är vanligt efter angiografi negativ SAB. Trots det återhämtar sig majoriteten av patienterna fullständigt. Våra fynd betonar vikten av specialiserad intensivvård för denna grupp av patienter.