Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
Neurosurgery. 2012 Aug;71(2):264-8; discussion 268-9. doi: 10.1227/NEU.0b013e318256c27d.
An acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome. Risk factors for the development of an aSDH from aneurysmal rupture are unknown and may help our understanding of how an aSDH develops.
To identify risk factors for the development of an aSDH from intracranial aneurysm rupture.
Patients were selected from our prospectively collected single-center SAH database. From all 1757 patients fulfilling prespecified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH. Univariable and multivariable risk ratios with corresponding 95% confidence intervals (CIs) were calculated for characteristics with Poisson regression.
Multivariable risk ratios were 1.021 (95% CI: 1.001-1.042) for each year increase in age, 2.3 (95% CI: 1.3-3.8) for posterior communicating artery aneurysms, 3.0 (95% CI: 1.5-6.0) for sentinel headache, and 5.2 (95% CI: 3.1-8.9) for ICH. None of the 95 patients (0%; 95% CI: 0%-3.8%) with a ruptured vertebrobasilar aneurysm had an aSDH, which was statistically significantly lower than at other sites (P = .02 for basilar aneurysm; P = .04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with an aSDH.
Increasing age, sentinel headache, ICH, and aneurysms at the posterior communicating artery are independent risk factors for an aSDH. Patients with a basilar or vertebral aneurysm have a low risk of an aSDH.
急性硬脑膜下血肿（aSDH）是颅内动脉瘤性蛛网膜下腔出血（SAH）的罕见并发症，与入院时的不良临床状况和不良预后相关。导致动脉瘤破裂后发生 aSDH 的危险因素尚不清楚，这些因素可能有助于我们了解 aSDH 的发展机制。
确定颅内动脉瘤破裂后发生 aSDH 的危险因素。
从我们前瞻性收集的单中心 SAH 数据库中选择患者。在满足预设纳入标准的 1757 名患者中，有 63 名患者发生了 aSDH。我们评估了性别、年龄、吸烟、高血压、SAH 病史、预警性头痛、破裂动脉瘤的位置和脑内血肿（ICH）作为发生 aSDH 的危险因素。使用泊松回归对具有特征性的单变量和多变量风险比及其相应的 95%置信区间（CI）进行了计算。
年龄每增加 1 岁，多变量风险比为 1.021（95%CI：1.001-1.042）；后交通动脉瘤为 2.3（95%CI：1.3-3.8）；预警性头痛为 3.0（95%CI：1.5-6.0）；ICH 为 5.2（95%CI：3.1-8.9）。没有基底动脉或椎动脉动脉瘤破裂的 95 名患者（0%；95%CI：0%-3.8%）发生 aSDH，与其他部位相比差异有统计学意义（基底动脉：P=.02；椎动脉：P=.04）。其他研究的特征与 aSDH 均无统计学显著相关性。
年龄增长、预警性头痛、ICH 和后交通动脉处的动脉瘤是发生 aSDH 的独立危险因素。基底动脉或椎动脉动脉瘤患者发生 aSDH 的风险较低。
