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Outcome Predictors of Non-Aneurysmal Spontaneous Subarachnoid Hemorrhage: A Retrospective Analysis in A Tertiary Care Center

Bhagwati Salgotra, Associate Professor, Department of Neurosurgey, SBKS Medical College, Vadodara, Gujarat 391760, India , Raghavendra Nayak1 , Bhagwati Salgotra2 , Nitin Jagdhane3

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International Journal of Neurology and Neurosurgery 10(3):p 260-263, Jul-Sep 2018. | DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10318.18

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Abstract

  Background: Non aneurysmal subarachnoid hemorrhage accounts for about 15% of all spontaneous subarachnoid hemorrhages. Literature has less data of outcome of these patients. To analyze factors affecting the outcome of patients with angio­negative subarachnoid hemorrhage (SAH). Methods: Retrospective analysis of data of patients with angio­negative SAH admitted in a tertiary care hospital from 2013 to 2018. Outcome was assessed according to the modified Rankin Scale (mRS) at 6 months. Results: Total 44 patients (18 Males, 16 Females with a ratio of 1.1:1) were included in the study. The mean age of presentation was 48.9±11.8. On imaging, 24 (55.5%) patients had perimesencephalic SAH (PM­SAH) and 20 (45.5%) had non­perimesencephalic SAH (NPM­SAH). Among 44 patients, 37 (84 %) of were clinically in good conditions (WFNS I/III) at presentation. 91% (22 out of 24) of patients with PMSAH had a good clinical status compared to the patients with NPM­SAH (75%) which clinically was not significant (p=0.13). 19 (43%) Patients were having arterial hypertension (Systolic BP >140). 10 (23%) patients were on anticoagulation medications. Overall, 12 (27%) patients developed an early hydrocephalus and required an EVD. Good outcome was seen in 35 (83%) patients. On multivariate analysis early hydrocephalus and poor admission clinical status emerged as an independent factors for the poor outcomes [Table 2]. Conclusions: Early onset hydrocephalus and poor admission WFNS grade are the independent predictor of poor outcomes. Permanent shunt dependency is significantly higher in patients with NPM­SAH. Patients with a NPM­SAH special attention as they have relatively poor neurological course compared to the patients with PM­SAH.

Keywords: Spontaneous Subarachnoid Hemorrhage; Perimesenchalic; Aneurysm; Angionegative.

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DOI: DOI: http://dx.doi.org/10.21088/ijnns.0975.0223.10318.18

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