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. 2023 Oct;165(10):2843-2853.
doi: 10.1007/s00701-023-05767-4. Epub 2023 Sep 2.

The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study

Jeremias Tarkiainen  1   2 , Valtteri Hovi  3   4 , Liisa Pyysalo  4   5 , Antti Ronkainen  3 , Juhana Frösen  3   4
Affiliations

The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study

Jeremias Tarkiainen et al. Acta Neurochir (Wien). 2023 Oct.

Erratum in

Abstract

Background: Non-aneurysmal subarachnoid hemorrhages (SAHs) are thought to have a benign clinical course compared to aneurysmal SAHs. The aim of this study is to report the clinical course and outcomes of non-aneurysmal SAHs in a large single-center study.

Methods: The patients with non-aneurysmal SAHs were screened from Tampere University Hospital from 2005 to 2020. The clinical data were collected from the patient's medical records and from the imaging studies. The primary interest was the neurological outcome assessed by dichotomized GOS at 2 months. Multivariable logistic regression was used to study the factors associated with unfavorable outcome.

Results: We found 216 non-aneurysmal SAHs in 214 patients (2 patients with > 1 bleed). Ninety-seven percent of patients with a typical perimesencephalic bleeding pattern SAH (PSAH) (75/77) had a favorable outcome, while 86% of patients with non-perimesencephalic SAH (NPSAH) had a favorable outcome (84/98). In a multivariable logistic regression analysis, loss of consciousness (LOC) (aOR 214.67, 95% CI 17.62-2615.89) and Fisher grade 4 bleeding pattern (aOR 23.32, 95% CI 1.40-387.98) were associated with increased risk for unfavorable outcome (GOS 1-3). Vasospasm was seen in 20% of non-aneurysmal SAH patients, hydrocephalus in 17%, and 13% needed ventriculostomy.

Conclusions: Non-aneurysmal SAH seems to have a good prognosis for majority of patients, especially for patients with a PSAH. Non-aneurysmal SAH patients are however affected by vasospasm and hydrocephalus and have similar risk factors for poor outcome as patients with aneurysmal SAH. This suggests that it is the severity of the bleed rather than the etiology that associates with poor outcome.

Keywords: Hydrocephalus; Loss of consciousness; Non-aneurysmal subarachnoid hemorrhage; Outcome; Vasospasm.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Non-aneurysmal SAHs with an unknown etiology. a Fisher grade 1 SAH. The diagnosis of SAH is based on lumbar puncture and b Fisher grade 2 SAH. c A typical non-aneurysmal SAH Fisher grade 3 SAH. d Fisher grade 4 non-aneurysmal SAH, the blood is also present in the fourth ventricle
Fig. 2
Fig. 2
A flowchart describing how the study cohort was formed. The cohort was formed by two screening methods in order to include all cases. As the two screening methods produced similar data, it also validates the comprehensiveness of the TAUH Aneurysm Database. *The group of patients with other reason for exclusion included patients of whom medical records were not available, patients with only native CT or patients of whom the bleeding source were eventually found, such as blister aneurysm or moyamoya disease
Fig. 3
Fig. 3
A flowchart describing how the follow-up was implemented. *Out of 3 patients with neurological deficits at discharge, one of them was included in the analysis of outcome due to only minor neurological deficits at discharge (GOS 5). Two patients were excluded from the outcome analysis as they were lost during follow-up with an uncertain condition
See this image and copyright information in PMC

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