Outcome and prognostic factors after delayed second subarachnoid haemorrhage.

Autor: Brawanski N; Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany. Nina.Brawanski@kgu.de., Platz J; Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany., Bruder M; Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany., Senft C; Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany., Berkefeld J; Institute of Neuroradiology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany., Seifert V; Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany., Konczalla J; Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany.
Jazyk: angličtina
Zdroj: Acta neurochirurgica [Acta Neurochir (Wien)] 2017 Feb; Vol. 159 (2), pp. 307-315. Date of Electronic Publication: 2016 Dec 10.
DOI: 10.1007/s00701-016-3045-4
Abstrakt: Background: Data of patients suffering from delayed second subarachnoid haemorrhage (SAH) after aneurysm treatment are still missing. Patients become clearly older than before. Thus, the risk suffering from a second delayed SAH rises. The aim of this study was to analyse clinical outcome and prognostic factors in patients after delayed second SAH.
Method: From 1999 to 2013, 18 of 1,493 patients (1.2%) suffered from a second SAH. Clinical and radiological characteristics were entered into a prospective conducted database. Outcome was assessed according to modified Rankin Scale 6 months after second SAH. P < 0.05 was considered statistically significant.
Results: Eighteen patients were admitted to our department with a second SAH. The second SAH occurred at a mean interval of 144 months after surgical treatment and 78 months after endovascular treatment (P < 0.05), with an overall mean interval of 125 months. The earliest event of second SAH was after 35 months. In 11 (61%) patients, a de novo aneurysm was detected; in one patient (6%), no cause of second SAH was detected. In six (33%) cases, re-rupture of the formerly secured aneurysm was found. Half of the rebleedings occurred from a basilar aneurysm, 33% from an aneurysm of anterior communicating artery and in one patient from a median cerebral artery aneurysm. At second SAH, 8 of 18 patients presented WFNS grade I-III at time of admission (44%). Overall, favourable outcome was achieved in seven patients (39%). Four patients died (22%), one of them before treatment. Favourable outcome seems to be associated with younger age. In our patients, 39% achieved a favourable outcome after second SAH.
Conclusions: A delayed second SAH is a rare entity. After delayed second SAH, age seems to be a prognostic factor for patients' outcome and patients seem to have a worse prognosis. Nonetheless, up to 40% of patients can achieve a favourable outcome.
Databáze: MEDLINE
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