Predictors of hemorrhage volume and disability after perimesencephalic subarachnoid hemorrhage
Citation Manager Formats
Make Comment
See Comments

This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
Objective: The determinants of subarachnoid hemorrhage (SAH) volume and an atypical pattern of blood are not clear. Our objective was to determine if reduced platelet activity on admission and abnormal venous drainage are associated with greater SAH volume.
Methods: We prospectively identified noncomatose patients with SAH without an identifiable aneurysm. We routinely measured platelet activity on admission and recorded aspirin use. SAH volumes were calculated with a validated technique. CT angiograms were reviewed by a certified neuroradiologist for venous drainage. Patients were followed for clinical outcomes through 3 months with the modified Rankin Scale (mRS). Data are Q1–Q3.
Results: There were 31 patients in the cohort. Thirty (97%) underwent an angiogram on admission, and 25 (81%) an additional delayed angiogram. SAH volume was lowest with normal venous drainage bilaterally (4.4 [3.7–16.4] mL) and higher with 1 (12.9 [3.7–20.4]) or 2 (20.9 [12.5–34.6] mL, p = 0.03) discontinuous venous drainages. Patients with reduced platelet activity had more SAH on the diagnostic CT (17.5 [10.6–20.9] vs 6.1 [2.3–15.3] mL) (p = 0.046). SAH volume was greater for patients requiring drainage for hydrocephalus (16.4 [11.5–20.5] vs 5.4 [2.7–16.4] mL) (p = 0.009). Outcomes at 3 months were generally excellent (median mRS = 0, no symptoms).
Conclusions: Discontinuous venous drainage and reduced platelet activity were associated with increased SAH volume and hydrocephalus. These factors may explain thick SAH and reduce the need for repeated invasive imaging in such patients.
GLOSSARY
- ARU=
- aspirin reaction unit;
- CTA=
- CT angiography;
- EVD=
- external ventricular drain;
- mRS=
- modified Rankin Scale;
- PM-SAH=
- perimesencephalic subarachnoid hemorrhage;
- SAH=
- subarachnoid hemorrhage
Footnotes
-
Supplemental data at www.neurology.org
- Received July 12, 2011.
- Accepted October 26, 2011.
- Copyright © 2012 by AAN Enterprises, Inc.
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Disputes & Debates: Rapid online correspondence
REQUIREMENTS
If you are uploading a letter concerning an article:
You must have updated your disclosures within six months: http://submit.neurology.org
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.