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Outcome and prognostic factors after delayed second subarachnoid haemorrhage

  • Original Article - Vascular
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Abstract

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.

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Acknowledgements

We thank Anne Sicking and Marina Heibel for their excellent technical support.

Authors’ contributions

J.K., J.P., M.B. and N.B. collected and analysed the data. J.K. performed statistical analysis. N.B. drafted the manuscript. C.S., J.B., J.K. and V.S. contributed to critical revision of the manuscript for important intellectual content. J.K. and V.S. critically supervised the manuscript. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany

    Nina Brawanski, Johannes Platz, Markus Bruder, Christian Senft, Volker Seifert & Juergen Konczalla

  2. Institute of Neuroradiology, Goethe-University Hospital Frankfurt, Schleusenweg 2-16, 60528, Frankfurt, Germany

    Joachim Berkefeld

Authors
  1. Nina Brawanski
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  2. Johannes Platz
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  3. Markus Bruder
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  4. Christian Senft
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  5. Joachim Berkefeld
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  6. Volker Seifert
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  7. Juergen Konczalla
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Corresponding author

Correspondence to Nina Brawanski.

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Competing interests

The authors declare that they have no competing interests.

Funding

No funding was received for this research.

Conflict of interest

J.B.: Consulting fee or honorarium: proctor for WEB, Sequent Medical and a member of the scientific advisory board of Acandis. There is a permanent scientific cooperation between Siemens Healthcare AG and the Institute of Neuroradiology and travel expenses for presentation of projects are covered by the company. Except this, all authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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For this type of study formal consent is not required.

Appendix 1

Appendix 1

Table 4 Summary of imaging done and aneurysm status
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Table 5 Characteristics overview at second SAH
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Brawanski, N., Platz, J., Bruder, M. et al. Outcome and prognostic factors after delayed second subarachnoid haemorrhage. Acta Neurochir 159, 307–315 (2017). https://doi.org/10.1007/s00701-016-3045-4

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  • DOI: https://doi.org/10.1007/s00701-016-3045-4

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