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Abstract
Objective To define the in-hospital course, complications, short- and long-term functional outcomes of patients with angiographically negative subarachnoid hemorrhage (anSAH), particularly those with aneurysmal-pattern anSAH (aanSAH).
Methods Retrospective cohort study of patients with aneurysmal subarachnoid hemorrhage (aSAH), aanSAH, and perimesencephalic-pattern anSAH (panSAH) treated at a single tertiary referral center between January 2006 and April 2018. Ninety-nine patients with anSAH (33 aanSAH and 66 panSAH) and 464 patients with aSAH were included in this study. Outcomes included symptomatic hydrocephalus requiring CSF drainage, need for ventriculoperitoneal shunt, radiographic vasospasm, delayed cerebral ischemia (DCI), radiographic infarction, disability level within 1 year of ictus, and at last clinical follow-up as defined by the modified Rankin Scale.
Results Patients with aanSAH and panSAH had similar rates of DCI and radiologic infarction, and patients with aanSAH had significantly lower rates compared to aSAH (p ≤ 0.018). Patients with aanSAH were more likely than those with panSAH to require temporary CSF diversion and ventriculoperitoneal shunt (p ≤ 0.03), with similar rates to those seen in aSAH. Only one patient with anSAH died in the hospital. Compared to those with aSAH, patients with aanSAH were significantly less likely to have a poor functional outcome within 1 year of ictus (odds ratio 0.26, 95% confidence interval 0.090–0.75) and at last follow-up (hazard ratio 0.30, 95% confidence interval 0.19–0.49, p = 0.002).
Conclusions DCI is very uncommon in anSAH, but patients with aanSAH have a similar need for short- and long-term CSF diversion to patients with aSAH. Nevertheless, patients with aanSAH have significantly better short- and long-term outcomes.
Glossary
- aanSAH=
- aneurysmal-pattern angiographically negative subarachnoid hemorrhage;
- anSAH=
- angiographically negative subarachnoid hemorrhage;
- aSAH=
- aneurysmal subarachnoid hemorrhage;
- CI=
- confidence interval;
- DCI=
- delayed cerebral ischemia;
- DSA=
- digital subtraction angiography;
- EVD=
- external ventricular drain;
- ICU=
- intensive care unit;
- IVH=
- intraventricular hemorrhage;
- LOS=
- length of stay;
- mRS=
- modified Rankin Scale;
- OR=
- odds ratio;
- panSAH=
- perimesencephalic-pattern subarachnoid hemorrhage;
- PMH=
- perimesencephalic hemorrhage;
- SAH=
- subarachnoid hemorrhage;
- TCD=
- transcranial Doppler;
- VPS=
- ventriculoperitoneal shunt;
- WFNS=
- World Federation of Neurosurgical Societies
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received August 30, 2018.
- Accepted in final form January 19, 2019.
- © 2019 American Academy of Neurology
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