• World Neurosurg · Oct 2017

    CVS-dependent and CVS-independent Cerebral Infarctions Predict Outcome after Non-Aneurysmal Subarachnoid Hemorrhage: a Single-Center Series with 250 Patients.

    • Juergen Konczalla, Sepide Kashefiolasl, Nina Brawanski, Markus Bruder, Florian Gessler, Christian Senft, Joachim Berkefeld, Volker Seifert, and Stephanie Tritt.
    • Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany. Electronic address: J.Konczalla@med.uni-frankfurt.de.
    • World Neurosurg. 2017 Oct 1; 106: 861-869.e4.

    ObjectiveThe number of patients with nonaneurysmal subarachnoid hemorrhage (naSAH) has increased during the last decade. Data regarding infarctions in naSAH are still limited. The aim of this study was to identify the rate of cerebral vasospasm (CVS)-dependent and CVS-independent infarctions and their influence on clinical outcomes.MethodsBetween 1999 and 2015, 250 patients suffering from naSAH were analyzed retrospectively. A delayed infarction was analyzed whether it was associated with CVS (CVS-dependent infarction) or not (CVS-independent).ResultsA total of 36 patients (14%) had cerebral infarctions. CVS was detected in 54 patients (22%), and 15 (6%) of them developed infarctions (CVS-dependent). Infarctions without signs of CVS (CVS-independent) occurred in 21 patients (8%). Overall, 86% of the patients had favorable outcome. Patients without cerebral infarctions had the best outcome (91% favorable outcome, 5% mortality rate). Patients with CVS-independent infarctions (57%) as well as patients with CVS-dependent infarctions (53%) had a favorable outcome less often. The mortality rate was also significantly greater in patients with CVS-independent (19%) and CVS-dependent infarctions (33%). A further independent predictor was anticoagulative therapy, which increased during study period and was associated with nonperimesencephalic blood distribution.ConclusionsCVS-dependent and independent infarctions occur in naSAH and contribute to unfavorable outcomes. Whereas CVS-independent infarctions occur in any subgroup, CVS-dependent infarctions seem to be associated with blood pattern (Fisher 3). Anticoagulative therapy seems to be not only a predictor for worse outcome but also for nonperimesencephalic SAH. Accordingly, the proportion of perimesencephalic and nonperimesencephalic SAH changed during the study period (from 2.2:1 to 1:1.7).Copyright © 2017 Elsevier Inc. All rights reserved.

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