Wilson Thomas J, Stetler William R, Davis Matthew C, Giles David A, Khan Adam, Chaudhary Neeraj, Gemmete Joseph J, Xi Guohua, Thompson B Gregory, Pandey Aditya S
Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, United States.
Department of Radiology, University of Michigan, Ann Arbor, Michigan, United States.
J Neurol Surg A Cent Eur Neurosurg. 2015 Mar;76(2):126-32. doi: 10.1055/s-0034-1394189. Epub 2014 Dec 29.
We hypothesized that the subset of patients with early hydrocephalus following aneurysmal subarachnoid hemorrhage may represent a subset of patients with a more vehement inflammatory reaction to blood products in the subarachnoid space. We thus examined risk factors for early hydrocephalus and examined the relationship between early hydrocephalus and symptomatic vasospasm as well as clinical outcome.
We retrospectively analyzed all patients presenting to our institution with subarachnoid hemorrhage over a 7-year period. We examined for risk factors, including early hydrocephalus, for poor clinical outcome and symptomatic vasospasm.
We found intraventricular hemorrhage to be strongly associated with the development of early hydrocephalus. In univariate analysis, early hydrocephalus was strongly associated with both poor functional outcome and symptomatic vasospasm. In multivariate analysis, intraventricular hemorrhage and tobacco use were associated with symptomatic vasospasm; intraventricular hemorrhage, intraparenchymal hemorrhage, and symptomatic vasospasm were associated with poor functional outcome.
We found that intraventricular hemorrhage was strongly associated with early hydrocephalus. Further exploration of the mechanistic explanation is needed, but we suggest this may be from a combination of obstruction of cerebrospinal fluid pathways by blood products and inflammation in the choroid plexus resulting in increased cerebrospinal fluid production. Further, we suggest that both early hydrocephalus and cerebral vasospasm may be parts of the overall inflammatory cascade that occurs with intraventricular hemorrhage and ultimately results in a poorer clinical outcome.
我们推测，动脉瘤性蛛网膜下腔出血后早期发生脑积水的患者亚组，可能代表了对蛛网膜下腔内血液产物有更强烈炎症反应的患者亚组。因此，我们研究了早期脑积水的危险因素，并探讨了早期脑积水与症状性血管痉挛以及临床结局之间的关系。
我们回顾性分析了7年间在我院就诊的所有蛛网膜下腔出血患者。我们研究了包括早期脑积水在内的不良临床结局和症状性血管痉挛的危险因素。
我们发现脑室内出血与早期脑积水的发生密切相关。在单因素分析中，早期脑积水与不良功能结局和症状性血管痉挛均密切相关。在多因素分析中，脑室内出血和吸烟与症状性血管痉挛相关；脑室内出血、脑实质内出血和症状性血管痉挛与不良功能结局相关。
我们发现脑室内出血与早期脑积水密切相关。需要进一步探究其机制解释，但我们认为这可能是由于血液产物阻塞脑脊液通路以及脉络丛炎症导致脑脊液生成增加共同作用的结果。此外，我们认为早期脑积水和脑血管痉挛可能都是脑室内出血时发生的整体炎症级联反应的一部分，最终导致较差的临床结局。
