Clinical complications and outcomes of angiographically negative subarachnoid hemorrhage

Cody L. Nesvick, Soliman Oushy, Lorenzo Rinaldo, Eelco F. Wijdicks, Giuseppe Lanzino, Alejandro Rabinstein

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To define the in-hospital course, complications, short- and long-term functional outcomes of patients with angiographically negative subarachnoid hemorrhage (anSAH), particularly those with aneurysmal-pattern anSAH (aanSAH). METHODS: Retrospective cohort study of patients with aneurysmal subarachnoid hemorrhage (aSAH), aanSAH, and perimesencephalic-pattern anSAH (panSAH) treated at a single tertiary referral center between January 2006 and April 2018. Ninety-nine patients with anSAH (33 aanSAH and 66 panSAH) and 464 patients with aSAH were included in this study. Outcomes included symptomatic hydrocephalus requiring CSF drainage, need for ventriculoperitoneal shunt, radiographic vasospasm, delayed cerebral ischemia (DCI), radiographic infarction, disability level within 1 year of ictus, and at last clinical follow-up as defined by the modified Rankin Scale. RESULTS: Patients with aanSAH and panSAH had similar rates of DCI and radiologic infarction, and patients with aanSAH had significantly lower rates compared to aSAH (p ≤ 0.018). Patients with aanSAH were more likely than those with panSAH to require temporary CSF diversion and ventriculoperitoneal shunt (p ≤ 0.03), with similar rates to those seen in aSAH. Only one patient with anSAH died in the hospital. Compared to those with aSAH, patients with aanSAH were significantly less likely to have a poor functional outcome within 1 year of ictus (odds ratio 0.26, 95% confidence interval 0.090-0.75) and at last follow-up (hazard ratio 0.30, 95% confidence interval 0.19-0.49, p = 0.002). CONCLUSIONS: DCI is very uncommon in anSAH, but patients with aanSAH have a similar need for short- and long-term CSF diversion to patients with aSAH. Nevertheless, patients with aanSAH have significantly better short- and long-term outcomes.

Original languageEnglish (US)
Pages (from-to)e2385-e2394
JournalNeurology
Volume92
Issue number20
DOIs
StatePublished - May 14 2019

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Subarachnoid Hemorrhage
Brain Ischemia
Ventriculoperitoneal Shunt
Infarction
Confidence Intervals
Hydrocephalus
Tertiary Care Centers
Curriculum
Drainage
Cohort Studies
Retrospective Studies
Odds Ratio

ASJC Scopus subject areas

  • Clinical Neurology

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Clinical complications and outcomes of angiographically negative subarachnoid hemorrhage. / Nesvick, Cody L.; Oushy, Soliman; Rinaldo, Lorenzo; Wijdicks, Eelco F.; Lanzino, Giuseppe; Rabinstein, Alejandro.

In: Neurology, Vol. 92, No. 20, 14.05.2019, p. e2385-e2394.

Research output: Contribution to journalArticle

Nesvick, CL, Oushy, S, Rinaldo, L, Wijdicks, EF, Lanzino, G & Rabinstein, A 2019, 'Clinical complications and outcomes of angiographically negative subarachnoid hemorrhage', Neurology, vol. 92, no. 20, pp. e2385-e2394. https://doi.org/10.1212/WNL.0000000000007501
Nesvick, Cody L. ; Oushy, Soliman ; Rinaldo, Lorenzo ; Wijdicks, Eelco F. ; Lanzino, Giuseppe ; Rabinstein, Alejandro. / Clinical complications and outcomes of angiographically negative subarachnoid hemorrhage. In: Neurology. 2019 ; Vol. 92, No. 20. pp. e2385-e2394.
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AU - Oushy, Soliman

AU - Rinaldo, Lorenzo

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AU - Lanzino, Giuseppe

AU - Rabinstein, Alejandro

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