Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 22;46(1):23.
doi: 10.1007/s10143-022-01919-9.

Hydrocephalus, cerebral vasospasm, and delayed cerebral ischemia following non-aneurysmatic spontaneous subarachnoid hemorrhages: an underestimated problem

Christina Wolfert  1 , Christoph J Maurer  2 , Ansgar Berlis  2 , Hauke Schneider  3 , Kathrin Steininger  4 , Stefan Motov  4 , Philipp Krauss  4 , Björn Sommer #  4 , Ehab Shiban #  4
Affiliations

Hydrocephalus, cerebral vasospasm, and delayed cerebral ischemia following non-aneurysmatic spontaneous subarachnoid hemorrhages: an underestimated problem

Christina Wolfert et al. Neurosurg Rev. .

Abstract

Non-aneurysmal subarachnoid hemorrhage (NASAH) is rare and mostly benign. However, complications such as cerebral vasospasm (CV), delayed cerebral ischemia (DCI), or post-hemorrhagic hydrocephalus (HC) may worsen the prognosis. The aim of this study was to evaluate the rate of these complications comparing perimesencephalic (PM) and non-perimesencephalic (NPM) SAH. Monocentric, retrospective analysis of patients diagnosed with NASAH from 01/2010 to 01/2021. Diagnosis was set only if vascular pathologies were excluded in at least one digital subtraction angiography, and NASAH was confirmed by cranial computed tomography (cCT) or lumbar puncture (LP). One hundred patients (62 female) with a mean age of 54.9 years (27-84) were identified. Seventy-three percent had a World Federation of Neurological Surgeons (WFNS) grading scale score I, while 9% were WFNS score IV or V at the time of admission. SAH was diagnosed by cCT in 86%, in 14% by lumbar puncture. Twenty-five percent necessitated short-term CSF diversion by extraventricular drainage or lumbar drainage, whereof 7 suffered from long-term HC treated with ventriculoperitoneal shunting (VPS). One patient without a short-term CSF drainage developed long-term HC. Ten percent developed CV, four of whom received intraarterial spasmolysis. Radiological DCI was diagnosed in 2%; none of these correlated with CV. Despite a mortality of 3% occurring solely in NPM SAH, the analyzed complication rate was comparable in both groups. We observed post-hemorrhagic complications in 35% of cases during the first 3 weeks after bleeding, predominantly in patients with NPM SAH. For this reason, close observation and cranial imaging within this time may be indicated not to overlook these complications.

Keywords: Cerebral vasospasm; Delayed cerebral ischemia; Hydrocephalus; Negative angiography; Occult subarachnoid hemorrhage; Outcome.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Number of patients screened and included for evaluation
Fig. 2
Fig. 2
WFNS grade at admission
See this image and copyright information in PMC

References

    1. van Gijn J, Rinkel GJE. Subarachnoid haemorrhage: diagnosis, causes and management. Brain. 2001;124:249–278. doi: 10.1093/brain/124.2.249. - DOI - PubMed
    1. Flaherty ML, et al. Perimesencephalic subarachnoid hemorrhage: incidence, risk factors, and outcome. J Stroke Cerebrovasc Dis. 2005;14:267–271. doi: 10.1016/j.jstrokecerebrovasdis.2005.07.004. - DOI - PMC - PubMed
    1. Rinkel GJ, et al. Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR Am J Neuroradiol. 1991;12:829–834. - PMC - PubMed
    1. Kang D-H, et al. Does non-perimesencephalic type non-aneurysmal subarachnoid hemorrhage have a benign prognosis? J Clin Neurosci. 2009;16:904–908. doi: 10.1016/j.jocn.2008.10.008. - DOI - PubMed
    1. Conzen C, et al. Baseline characteristics and outcome for aneurysmal versus non-aneurysmal subarachnoid hemorrhage: a prospective cohort study. Neurosurg Rev. 2021 doi: 10.1007/s10143-021-01650-x. - DOI - PMC - PubMed

MeSH terms