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Vasospasm after spontaneous angiographically negative subarachnoid hemorrhage

  • Clinical Article
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Abstract

Background

Vasospasm, delayed infarcts and clinical deterioration due to delayed cerebral ischemia (CD-DCI) following digital subtraction angiography (DSA)-negative, spontaneous subarachnoid hemorrhage (SAH) are infrequently and inconsistently described in the literature.

Methods

To quantify and characterize rates of each, we reviewed our own series of 77 patients with DSA-negative, spontaneous SAH. Employing a PubMed search, we reviewed the literature and calculated directly adjusted overall rates of vasospasm, delayed infarcts and CD-DCI.

Results

In our own patient cohort, 26 % of patients suffered vasospasm, 4 % delayed infarcts and 4 % CD-DCI. Higher Hunt-Hess grade and diffuse SAH pattern were associated with higher rates of each. Incorporating results from 18 studies in the literature, the directly adjusted overall rate of vasospasm following DSA-negative SAH was 16.3 % (95 % CI 12.3-21.1). Adjusted overall rates of delayed infarcts and CD-DCI were 3.4 % (95 % CI 1.9-5.5) and 6.8 % (95 % CI 5.0-9.1), respectively. For the subgroup of patients with diffuse SAH, the rates of vasospasm and CD-DCI were 31.3 % (95 % CI 21.6-43.9) and 9.7 % (95 % CI 7.0-13.0), respectively, while in patients with perimesencephalic SAH, respective rates were 13.1 % (95 % CI 7.7-20.7) and 2.4 % (95 % CI 1.0-4.8). A mixed-effects meta-analysis revealed an odds ratio for CD-DCI in diffuse SAH compared to perimesencephalic SAH of 3.79 (p = 0.009).

Conclusion

Although they are seen less frequently in patients with DSA-negative spontaneous SAH, vasospasm, delayed infarcts and CD-DCI do occur and may require endovascular therapy. Risk factors include a diffuse hemorrhage pattern and higher Hunt-Hess grade.

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Authors and Affiliations

  1. Department of Neurological Surgery, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA

    Bradley A. Gross, Ning Lin, Kai U. Frerichs & Rose Du

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  1. Bradley A. Gross
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  2. Ning Lin
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  3. Kai U. Frerichs
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  4. Rose Du
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Correspondence to Rose Du.

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Gross, B.A., Lin, N., Frerichs, K.U. et al. Vasospasm after spontaneous angiographically negative subarachnoid hemorrhage. Acta Neurochir 154, 1127–1133 (2012). https://doi.org/10.1007/s00701-012-1383-4

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  • DOI: https://doi.org/10.1007/s00701-012-1383-4

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