Wen Dingke, Chen Ruiqi, Zhang Tianjie, Li Hao, Zheng Jun, Fu Wei, You Chao, Ma Lu
Department of Neurosurgery, West China hospital, Sichuan University, Chengdu, China.
Front Surg. 2022 Jul 8;9:927351. doi: 10.3389/fsurg.2022.927351. eCollection 2022.
Thunderclap-like severe headache or consciousness disturbance is the common "typical" clinical presentation after aneurysmal subarachnoid hemorrhage (aSAH); however, a slowly developing "atypical" clinical pattern, with mild headache, vomiting, or dizziness, is frequently noted in elderly patients. The aim of this study was to evaluate the clinical characteristics of this "atypical" subgroup, as well as related factors associated with the presence of these mild symptoms.
The data of 176 elderly patients (≥70 years old) with ruptured intracranial aneurysms (IAs) treated at our center from January 2016 to January 2020 were retrospectively collected and analyzed. The patients were divided into "typical" and "atypical" groups based on their initial and development of clinical symptoms after the diagnosis of aSAH. Intergroup differences were analyzed, and factors related to the presence of these two clinical patterns were explored through multiple logistic regression analyses.
Despite significant admission delay ( < 0.001) caused by mild initial symptoms with slow development, patients in the "atypical" group achieved better clinical prognosis, as indicated by a significantly higher favourable outcome ratio and lower death rate upon discharge and at different time points during the 1-year follow-up, than the "typical" group ( < 0.05). Multiple logistic regression analysis revealed that modified Fisher grade III-IV (OR = 11.182, = 0.003), brain atrophy (OR = 10.010, = 0.001), a larger lesion diameter (OR = 1.287, < 0.001) and current smoking (OR = 5.728, < 0.001) were independently associated with the presence of "typical" symptoms. Aneurysms with wide necks (OR = 0.013, < 0.001) were independently associated with the presence of "atypical" symptoms.
"Atypical" presentations, with mild clinical symptoms and slow development, were commonly recorded in elderly patients after the onset of aSAH. Despite the prolonged admission delay, these "atypical" patients achieved better clinical outcomes than those with "typical" symptoms. Modified Fisher grade (III-IV), current smoking, brain atrophy and larger lesion diameter were factors predictive of "typical" symptoms, while aneurysms with wide necks were independently associated with "atypical" symptoms.
霹雳样剧烈头痛或意识障碍是动脉瘤性蛛网膜下腔出血（aSAH）后常见的“典型”临床表现；然而，老年患者中常出现缓慢发展的“非典型”临床模式，表现为轻度头痛、呕吐或头晕。本研究旨在评估这一“非典型”亚组的临床特征，以及与这些轻微症状出现相关的因素。
回顾性收集并分析了2016年1月至2020年1月在本中心接受治疗的176例颅内动脉瘤（IA）破裂的老年患者（≥70岁）的数据。根据aSAH诊断后临床症状的初始情况及发展过程，将患者分为“典型”组和“非典型”组。分析组间差异，并通过多因素逻辑回归分析探索与这两种临床模式出现相关的因素。
尽管初始症状轻微且发展缓慢导致显著的入院延迟（<0.001），但“非典型”组患者的临床预后较好，表现为在出院时以及1年随访期间不同时间点的良好结局率显著更高，死亡率更低，优于“典型”组（<0.05）。多因素逻辑回归分析显示，改良Fisher分级III-IV级（OR = 11.182，= 0.003）、脑萎缩（OR = 10.010，= 0.001）、病变直径较大（OR = 1.287，< 0.001）和当前吸烟（OR = 5.728，< 0.001）与“典型”症状的出现独立相关。宽颈动脉瘤（OR = 0.013，< 0.001）与“非典型”症状的出现独立相关。
aSAH发病后，老年患者中常见具有轻微临床症状且发展缓慢的“非典型”表现。尽管入院延迟延长，但这些“非典型”患者的临床结局优于具有“典型”症状的患者。改良Fisher分级（III-IV级）、当前吸烟、脑萎缩和病变直径较大是“典型”症状的预测因素，而宽颈动脉瘤与“非典型”症状独立相关。
