Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany.
Department of Neurosurgery, Justus Liebig University Giessen, Giessen, Germany.
World Neurosurg. 2022 Sep;165:e512-e519. doi: 10.1016/j.wneu.2022.06.086. Epub 2022 Jun 24.
To demonstrate the clinical outcome of patients with nonperimesencephalic subarachnoid hemorrhage (npSAH) compared with patients with aneurysmal SAH (aSAH) and perimesencephalic SAH (pSAH) and to evaluate predictive value of various clinical and radiological findings in patients with npSAH.
We retrospectively identified patients with SAH who presented at our institution between 2009 and 2018. We analyzed demographic and clinical data and outcomes. Multivariable analysis was performed for outcome parameters.
Of 608 patients with confirmed SAH, 78% had aSAH, and 22% had nonaneurysmal SAH. Nonaneurysmal SAH was perimesencephalic in 30% of cases and nonperimesencephalic in 70%. Initial clinical status (Hunt and Hess score) was significantly worse in patients with aSAH compared with patients with nonaneurysmal SAH. Complications such as delayed cerebral ischemia occurred significantly more often in patients with aSAH. Patients with pSAH had a more favorable clinical course than patients with aSAH or npSAH. There was no significant difference in 30-day mortality between aSAH (29%) and npSAH (28%) patients (P = 0.835). Hunt and Hess score emerged as a strong predictor of unfavorable outcome in both aSAH and npSAH in multivariable regression.
Patients with npSAH had a similar clinical outcome as patients with aSAH, although there were significantly fewer clinical complications in patients with npSAH. Patients with pSAH demonstrated an overall good clinical course. Our multivariable analysis showed that initial Hunt and Hess score was an important predictor for clinical outcome in aSAH as well as npSAH.
与动脉瘤性蛛网膜下腔出血（aSAH）和脑周围性蛛网膜下腔出血（pSAH）患者相比，展示非脑周围性蛛网膜下腔出血（npSAH）患者的临床结局，并评估 npSAH 患者各种临床和影像学发现的预测价值。
我们回顾性地确定了 2009 年至 2018 年期间在我院就诊的蛛网膜下腔出血患者。我们分析了人口统计学和临床数据及结果。对结果参数进行了多变量分析。
在 608 例确诊为蛛网膜下腔出血的患者中，78%为 aSAH，22%为非动脉瘤性蛛网膜下腔出血。非动脉瘤性蛛网膜下腔出血中有 30%为脑周围性，70%为非脑周围性。与非动脉瘤性蛛网膜下腔出血患者相比，aSAH 患者的初始临床状态（Hunt 和 Hess 评分）明显更差。并发症如迟发性脑缺血在 aSAH 患者中更为常见。与 aSAH 或 npSAH 患者相比，pSAH 患者的临床病程更为有利。aSAH（29%）和 npSAH（28%）患者的 30 天死亡率无显著差异（P=0.835）。Hunt 和 Hess 评分在多变量回归中是 aSAH 和 npSAH 不良结局的有力预测因素。
npSAH 患者的临床结局与 aSAH 患者相似，尽管 npSAH 患者的临床并发症明显较少。pSAH 患者表现出总体良好的临床病程。我们的多变量分析表明，初始 Hunt 和 Hess 评分是 aSAH 和 npSAH 患者临床结局的重要预测因素。
