Demirgil B T, Tugcu B, Postalci L, Guclu G, Dalgic A, Oral Z
2nd Neurosurgery Clinic, Bakirkoy Psychiatric and Neurological Diseases Hospital, 34010 Istanbul, Turkey.
Minim Invasive Neurosurg. 2003 Dec;46(6):344-8. doi: 10.1055/s-2003-812500.
Hydrocephalus is not a rare complication following aneurysmal subarachnoid hemorrhage. Hydrocephalus following subarachnoid hemorrhage can progress acutely (0-3 days), subacutely (4-13 days) or chronically (after 13 days). The predisposing factors leading to hydrocephalus after subarachnoid hemorrhage are not known exactly. This study assessed the predictive factors for the development of this condition. All patients presenting with subarachnoid hemorrhage between 1992-2001 were evaluated. All of them had initial computed tomography (CT) and hydrocephalus was diagnosed on CT scans. Age, gender, preexisting diabetes mellitus and hypertension, neurological state according to the Hunt and Hess scale at admission, Fischer grade on CT, the presence of intraventricular hemorrhage and localization of aneurysm were analyzed to see if there was any meaningful relationship between hydrocephalus and these factors. One hundred and fourteen patients with aneurysmal subarachnoid hemorrhage were evaluated. The incidence of hydrocephalus was 28.1 %. The incidence for acute hydrocephalus was 18.4 %, for subacute 5.2 % and for chronic 4.3 %. Sixty-nine percent of patients with hydrocephalus were graded as 3, 4 or 5 according to the Hunt and Hess scale on admission. Fifty-five percent of patients with hydrocephalus were graded as 3 and 4 according to Fisher grade on initial CT scan. Preexisting diabetes, higher Fisher grade and intraventricular hemorrhage were statistically significant predictors for the development of hydrocephalus. But only preexisting diabetes and higher Fisher grade were independent predictors according to multivariate analyses.
脑积水是动脉瘤性蛛网膜下腔出血后并不罕见的并发症。蛛网膜下腔出血后的脑积水可急性进展（0 - 3天）、亚急性进展（4 - 13天）或慢性进展（13天后）。蛛网膜下腔出血后导致脑积水的易感因素尚不完全清楚。本研究评估了发生这种情况的预测因素。对1992年至2001年间所有出现蛛网膜下腔出血的患者进行了评估。他们均进行了初次计算机断层扫描（CT），且脑积水通过CT扫描诊断。分析了年龄、性别、既往糖尿病和高血压情况、入院时根据Hunt和Hess量表评估的神经状态、CT上的Fischer分级、脑室内出血的存在情况以及动脉瘤的位置，以查看脑积水与这些因素之间是否存在任何有意义的关系。对114例动脉瘤性蛛网膜下腔出血患者进行了评估。脑积水的发生率为28.1%。急性脑积水的发生率为18.4%，亚急性为5.2%，慢性为4.3%。69%的脑积水患者入院时根据Hunt和Hess量表分级为3、4或5级。55%的脑积水患者初次CT扫描时根据Fisher分级为3级和4级。既往糖尿病、较高的Fisher分级和脑室内出血是脑积水发生的统计学显著预测因素。但根据多变量分析，只有既往糖尿病和较高的Fisher分级是独立预测因素。
