Spontaneous angiogram-negative subarachnoid hemorrhage : a retrospective single center cohort study

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Achren , A , Raj , R , Siironen , J , Laakso , A & Marjamaa , J 2022 , ' Spontaneous angiogram-negative subarachnoid hemorrhage : a retrospective single center cohort study ' , Acta Neurochirurgica , vol. 164 , no. 1 , pp. 129-140 . https://doi.org/10.1007/s00701-021-05069-7

Title: Spontaneous angiogram-negative subarachnoid hemorrhage : a retrospective single center cohort study
Author: Achren, Alexander; Raj, Rahul; Siironen, Jari; Laakso, Aki; Marjamaa, Johan
Contributor organization: HUS Neurocenter
Neurokirurgian yksikkö
Helsinki University Hospital Area
HUS Helsinki and Uusimaa Hospital District
Department of Neurosciences
Date: 2022-01
Language: eng
Number of pages: 12
Belongs to series: Acta Neurochirurgica
ISSN: 0001-6268
DOI: https://doi.org/10.1007/s00701-021-05069-7
URI: http://hdl.handle.net/10138/340552
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 (GOS) at 3 months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results Of the 108 patients included, 84% had a favorable outcome (GOS 4-5), and mortality was 5% within 1 year. The 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 percent 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. 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. The high rate of SAH-related complications highlights the need for neurosurgical care in these patients.
Subject: Subarachnoid hemorrhage
Perimesencephalic subarachnoid hemorrhage
Intensive care unit
Spontaneous subarachnoid hemorrhage
3112 Neurosciences
3124 Neurology and psychiatry
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion

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