Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland.
Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland.
Acta Neurochir (Wien). 2023 Oct;165(10):2843-2853. doi: 10.1007/s00701-023-05767-4. Epub 2023 Sep 2.
Non-aneurysmal subarachnoid hemorrhages (SAHs) are thought to have a benign clinical course compared to aneurysmal SAHs. The aim of this study is to report the clinical course and outcomes of non-aneurysmal SAHs in a large single-center study.
The patients with non-aneurysmal SAHs were screened from Tampere University Hospital from 2005 to 2020. The clinical data were collected from the patient's medical records and from the imaging studies. The primary interest was the neurological outcome assessed by dichotomized GOS at 2 months. Multivariable logistic regression was used to study the factors associated with unfavorable outcome.
We found 216 non-aneurysmal SAHs in 214 patients (2 patients with > 1 bleed). Ninety-seven percent of patients with a typical perimesencephalic bleeding pattern SAH (PSAH) (75/77) had a favorable outcome, while 86% of patients with non-perimesencephalic SAH (NPSAH) had a favorable outcome (84/98). In a multivariable logistic regression analysis, loss of consciousness (LOC) (aOR 214.67, 95% CI 17.62-2615.89) and Fisher grade 4 bleeding pattern (aOR 23.32, 95% CI 1.40-387.98) were associated with increased risk for unfavorable outcome (GOS 1-3). Vasospasm was seen in 20% of non-aneurysmal SAH patients, hydrocephalus in 17%, and 13% needed ventriculostomy.
Non-aneurysmal SAH seems to have a good prognosis for majority of patients, especially for patients with a PSAH. Non-aneurysmal SAH patients are however affected by vasospasm and hydrocephalus and have similar risk factors for poor outcome as patients with aneurysmal SAH. This suggests that it is the severity of the bleed rather than the etiology that associates with poor outcome.
与动脉瘤性蛛网膜下腔出血（aSAH）相比，非动脉瘤性蛛网膜下腔出血（nSAH）被认为具有良性临床过程。本研究旨在报告在一项大型单中心研究中 nSAH 的临床过程和结局。
从 2005 年至 2020 年，在坦佩雷大学医院筛选出 nSAH 患者。从患者的病历和影像学研究中收集临床数据。主要研究兴趣是通过 2 个月时的二分 GOS 评估的神经功能结局。多变量逻辑回归用于研究与不良结局相关的因素。
我们在 214 例患者中发现了 216 例 nSAH（2 例患者有 > 1 次出血）。75/77 例具有典型间脑周围出血模式 SAH（PSAH）的患者有良好结局，84/98 例非间脑周围出血模式 SAH（NPSAH）患者有良好结局。在多变量逻辑回归分析中，意识丧失（LOC）（优势比 214.67，95%置信区间 17.62-2615.89）和 Fisher 分级 4 出血模式（优势比 23.32，95%置信区间 1.40-387.98）与不良结局（GOS 1-3）的风险增加相关。20%的 nSAH 患者出现血管痉挛，17%出现脑积水，13%需要脑室造口术。
nSAH 似乎对大多数患者具有良好的预后，尤其是 PSAH 患者。然而，nSAH 患者受到血管痉挛和脑积水的影响，与 aSAH 患者不良结局的风险因素相似。这表明与不良结局相关的是出血的严重程度，而不是病因。
