Nogueira João, Meireles Bernardo, Pereira Renato, Ribeiro Pedro, Marques Renata, Afonso Filipe Miguel, Coimbra Frederica
Neurosurgery, Hospital de Braga, Braga, PRT.
Neurosurgery, Escola de Medicina da Universidade do Minho, Braga, PRT.
Cureus. 2024 Dec 12;16(12):e75596. doi: 10.7759/cureus.75596. eCollection 2024 Dec.
Introduction A large majority of spontaneous subarachnoid hemorrhages (SAH) are attributed to aneurysm rupture, though the cause remains unknown in a notable percentage of cases. Non-aneurysmal SAH (naSAH) is generally thought to follow a more benign clinical course than aneurysmal SAH (aSAH); however, similar complications may occur, and poor outcomes are still possible. Given the limited research on naSAH, this study aims to characterize these patients and correlate clinical and radiographic findings with outcomes. Methods A cohort of 149 patients with naSAH was selected from 2014 to 2023. Outcomes were assessed using the modified Rankin Scale (mRS), categorizing results as favorable (mRS 0-2) or unfavorable (mRS 3-6). Descriptive analysis was conducted, dividing the sample into two groups based on blood distribution on computed tomography scan: pretruncal (pnSAH) and non-pretruncal SAH (npnSAH). Associations between variables were tested, and a multivariable logistic regression was performed to identify significant predictors. Results The mean age was 57.54 years, with 79 males (53.0%) and 70 females (47.0%). A favorable outcome was observed in 133 patients (89.3%). Age, chronic hypertension, anticoagulant, and antiplatelet therapy were significant predictors of poor outcome (p < 0.05). A favorable World Federation of Neurosurgical Societies (WFNS) grade (I-III) was recorded in 88.6% of patients and was significantly associated with outcome (p < 0.05). Among the patients with unfavorable outcomes, 87.5% exhibited a npnSAH pattern. Rebleeding was rare, with only one case (0.7%). Acute hydrocephalus was the primary complication observed in naSAH cases (19.5%). Conclusions Patients with a npnSAH pattern were significantly more likely to experience unfavorable outcomes compared to those with a pnSAH pattern. In multivariate regression analysis, WFNS classification, bleeding pattern (pnSAH vs. npnSAH), and acute hydrocephalus were identified as independent predictors of poor outcomes.
引言 大多数自发性蛛网膜下腔出血（SAH）归因于动脉瘤破裂，尽管在相当比例的病例中病因仍不明。非动脉瘤性SAH（naSAH）通常被认为比动脉瘤性SAH（aSAH）的临床病程更良性；然而，类似的并发症可能发生，不良结局仍有可能。鉴于对naSAH的研究有限，本研究旨在对这些患者进行特征描述，并将临床和影像学结果与结局相关联。方法 从2014年至2023年选取了149例naSAH患者。使用改良Rankin量表（mRS）评估结局，将结果分为良好（mRS 0 - 2）或不良（mRS 3 - 6）。进行描述性分析，根据计算机断层扫描上的血液分布将样本分为两组：脑干前（pnSAH）和非脑干前SAH（npnSAH）。测试变量之间的关联，并进行多变量逻辑回归以确定显著的预测因素。结果 平均年龄为57.54岁，男性79例（53.0%），女性70例（47.0%）。133例患者（89.3%）观察到良好结局。年龄、慢性高血压、抗凝和抗血小板治疗是不良结局的显著预测因素（p < 0.05）。88.6%的患者记录到良好的世界神经外科联合会（WFNS）分级（I - III），且与结局显著相关（p < 0.05）。在结局不良的患者中，87.5%表现为npnSAH模式。再出血罕见，仅1例（0.7%）。急性脑积水是naSAH病例中观察到的主要并发症（19.5%）。结论 与pnSAH模式的患者相比，npnSAH模式的患者发生不良结局的可能性显著更高。在多变量回归分析中，WFNS分级、出血模式（pnSAH与npnSAH）和急性脑积水被确定为不良结局的独立预测因素。
