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. 2023 Aug 7;13(1):12805.
doi: 10.1038/s41598-023-39195-2.

Management of perimesencephalic nonaneurysmal subarachnoid hemorrhage: a national survey

Christina Wolfert  1 , Christoph J Maurer  2 , Björn Sommer  3 , Kathrin Steininger  3 , Stefan Motov  3 , Maximilian-Niklas Bonk  3 , Philipp Krauss  3 , Ansgar Berlis #  2 , Ehab Shiban #  3
Affiliations

Management of perimesencephalic nonaneurysmal subarachnoid hemorrhage: a national survey

Christina Wolfert et al. Sci Rep. .

Abstract

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (NASAH) is a rare type of subarachnoid hemorrhage (SAH), usually associated with minor complications compared to aneurysmal SAH. Up to date, data is scarce and consensus on therapeutic management and follow-up diagnostics of NASAH is often missing. This survey aims to evaluate the clinical management among neurosurgical departments in Germany. 135 neurosurgical departments in Germany received a hardcopy questionnaire. Encompassing three case vignettes with minor, moderate and severe NASAH on CT-scans and questions including the in-hospital treatment with initial observation, blood pressure (BP) management, cerebral vasospasm (CV) prophylaxis and the need for digital subtraction angiography (DSA). 80 departments (59.2%) answered the questionnaire. Whereof, centers with a higher caseload state an elevated complication rate (Chi2 < 0.001). Initial observation on the intensive care unit is performed in 51.3%; 47.5%, 70.0% in minor, moderate and severe NASAH, respectively. Invasive BP monitoring is performed more often in severe NASAH (52.5%, 55.0%, 71.3% minor, moderate, severe). CV prophylaxis and transcranial doppler ultrasound (TCD) are performed in 41.3%, 45.0%, 63.8% in minor, moderate and severe NASAH, respectively. Indication for a second DSA is set in the majority of centers, whereas after two negative ones, a third DSA is less often indicated (2nd: 66.2%, 72.5%, 86.2%; 3rd: 3.8%, 3.8%, 13.8% minor, moderate, severe). This study confirms the influence of bleeding severity on treatment and follow-up of NASAH patients. Additionally, the existing inconsistency of treatment pathways throughout Germany is highlighted. Therefore, we suggest to conceive new treatment guidelines including this finding.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Case vignettes of minor, moderate and severe NASAH.
Figure 2
Figure 2
STROBE dataset of included questionnaires.
Figure 3
Figure 3
Case load per neurosurgical department.
Figure 4
Figure 4
CV or CV related complications with the need for further treatment.
See this image and copyright information in PMC

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