Abstract
Purpose
Non-aneurysmal subarachnoid hemorrhage (NA-SAH) is a clinical-radiological entity with a different prognosis than aneurysmal SAH (A-SAH). The purpose of this study is to assess the predictive value of the modified Fisher Scale (mFS) for neurological complications in patients with this diagnosis.
Methods
We recruited patients admitted at our hospital services between 2009 and 2017 who were diagnosed with spontaneous SAH, with either perimesencephalic (PM-SAH) or diffuse pattern (D-SAH), an initial negative angio-CT, and at least one digital subtraction angiography of brain vessels discarding underlying brain aneurysms or other vascular malformations.
Results
The retrospective observational study included 116 patients. The mean age was 54.4, and the sample included predominantly male subjects (62.9%). Hunt and Hess (HH) scores on admission ranged from 3 to 5 in 18.1% of patients. The prevalence of hydrocephalus requiring ventricular drainage was 18.1%. The prevalence of symptomatic vasospasm was 4.3%. A modified Rankin Scale (mRS) 0–2 at discharge was found in 95.6%. In a multivariate logistic regression for the presence of neurological complications including age, sex, admission HH 3-5 compared with < 3, mFS 4 compared with mFS < 4, D-SAH compared with PM-SAH, and mRS score at discharge of 0–2 compared with > 2, the only significant predictors were mFS 4 compared with mFS < 4 (OR 4.47 (95% CI 1.21, 16.66) p value = 0.03) and D-SAH compared with PM-SAH (OR 7.10 (95% CI 1.24, 40.8) p value = 0.03).
Conclusion
In patients with NA-SAH, a mFS score of 4 and/or a D-SAH bleeding pattern in non-contrast cranial CT on admission predicted the development of relevant neurological complications.
Similar content being viewed by others
References
Marder CP, Narla V, Fink JR, Tozer Fink KR (2014) Subarachnoid hemorrhage: beyond aneurysms. AJR Am J Roentgenol 202(1):25–37
Kawamura Y, Narumi O, Chin M, Yamagata S (2011) Variant deep cerebral venous drainage in idiopathic subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 51(2):97–100
Daenekindt T, Wilms G, Thijs V, Demaerel P, Van Calenbergh F (2008) Variants of the basal vein of Rosenthal and perimesencephalic nonaneurysmal hemorrhage. Surg Neurol 69(5):526–529
Konczalla J, Platz J, Schuss P, Vatter H, Seifert V, Güresir E (2014) Non-aneurysmal non-traumatic subarachnoid hemorrhage: patient characteristics, clinical outcome and prognostic factors based on a single-center experience in 125 patients. BMC Neurol 14:140
Zhong W, Zhao P, Wang D, Li G, Sun H, Chen H et al (2014) Different clinical characteristics between perimesencephalic subarachnoid hemorrhage and diffuse subarachnoid hemorrhage with negative initial angiography. Turk Neurosurg 24(3):327–332
Pyysalo LM, Niskakangas TT, Keski-Nisula LH, Kähärä VJ, Öhman JE (2011) Long term outcome after subarachnoid haemorrhage of unknown aetiology. J Neurol Neurosurg Psychiatry 82(11):1264–1266
Frontera JA, Claassen J, Schmidt JM, Wartenberg KE, Temes R, Connolly ES, Macdonald RL, Mayer SA (2006) Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher Scale. Neurosurgery 59(1):21–27 discussion 21-7
van Gijn J, van Dongen KJ, Vermeulen M, Hijdra A (1985) Perimesencephalic hemorrhage: a nonaneurysmal and benign form of subarachnoid hemorrhage. Neurology 35:493–497
Rinkel GJ, Wijdicks EF, Vermeulen M, Ramos LM, Tanghe HL, Hasan D, Meiners LC, van Gijn J (1991) Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. AJNR Am J Neuroradiol 12:829–834
Coelho LG, Costa JM, Silva EI (2016) Non-aneurysmal spontaneous subarachnoid hemorrhage: perimesencephalic versus non-perimesencephalic. Rev Bras Ter Intensiva 28(2):141–146
Konczalla J, Schmitz J, Kashefiolasl S, Senft C, Seifert V, Platz J (2015) Non-aneurysmal subarachnoid hemorrhage in 173 patients: a prospective study of long-term outcome. Eur J Neurol 22(10):1329–1336
Mensing LA, Vergouwen MDI, Laban KG, Ruigrok YM, Velthuis BK, Algra A, Rinkel GJE (2018) Perimesencephalic hemorrhage: a review of epidemiology, risk factors, presumed cause, clinical course, and outcome. Stroke 49(6):1363–1370
Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28(1):14–20
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607
Sprenker C, Patel J, Camporesi E, Vasan R, Loveren HV, Chen H et al (2015) Medical and neurologic complications of the current management strategy of angiographically negative nontraumatic subarachnoid hemorrhage patients. J Crit Care 30(1):216.e7–216.11
Lin N, Zenonos G, Kim AH, Nalbach SV, Du R, Frerichs KU et al (2012) Angiogram-negative subarachnoid hemorrhage: relationship between bleeding pattern and clinical outcome. Neurocrit Care 16(3):389–398
Schuss P, Hadjiathanasiou A, Brandecker S, Wispel C, Borger V, Güresir Á, Vatter H, Güresir E (2019) Risk factors for shunt dependency in patients suffering from spontaneous, non-aneurysmal subarachnoid hemorrhage. Neurosurg Rev 42(1):139–145
Mohan M, Islim AI, Rasul FT, Rominiyi O, deSouza RM, Poon M et al (2019) Subarachnoid haemorrhage with negative initial neurovascular imaging: a systematic review and meta-analysis. Acta Neurochir (Wien) 161(10):2013–2026
Whiting J, Reavey-Cantwell J, Velat G, Fautheree G, Firment C, Lewis S, Hoh B (2009) Clinical course of nontraumatic, nonaneurysmal subarachnoid hemorrhage: a single-institution experience. Neurosurg Focus 26(5):E21
Raya A, Zipfel GJ, Diringer MN, Dacey R, Derdeyn CP, Rich KM et al (2014) Pattern not volume of bleeding predicts angiographic vasospasm in nonaneurysmal subarachnoid hemorrhage. Stroke 45(1):265–267
Kolias AG, Sen J, Belli A (2009) Pathogenesis of cerebral vasospasm following aneurysmal subarachnoid hemorrhage: putative mechanisms and novel approaches. J Neurosci Res 87(1):1–11
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflicts of interest
The authors declare that they have no conflict of interest.
Ethics approval
The Clinical Investigation Ethics Committee (CEIC) of Hospital Clínico Universitario Virgen de la Arrixaca approved the research protocol. All the procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Páez-Granda, D., Parrilla, G., Díaz-Pérez, J. et al. Are modified Fisher Scale and bleeding pattern helpful predictors of neurological complications in non-aneurysmal subarachnoid hemorrhage?. Neuroradiology 63, 253–257 (2021). https://doi.org/10.1007/s00234-020-02524-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-020-02524-7