Acta Neurochirurgica

, Volume 160, Issue 7, pp 1393–1400 | Cite as

Vasospasm-related complications after subarachnoid hemorrhage: the role of patients’ age and sex

  • Marvin Darkwah Oppong
  • Antonella Iannaccone
  • Oliver Gembruch
  • Daniela Pierscianek
  • Mehdi Chihi
  • Philipp Dammann
  • Angela Köninger
  • Oliver Müller
  • Michael Forsting
  • Ulrich Sure
  • Ramazan Jabbarli
Original Article - Vascular Neurosurgery - Aneurysm



Outcome of aneurysmal subarachnoid hemorrhage (SAH) depends strongly on occurrence of symptomatic vasospasm (SV) leading to delayed cerebral ischemia (DCI). Various demographic, radiographic, and clinical predictors of SV have been reported so far, partially with conflicting results. The aim of this study was to analyze the role of patients’ age and sex on SV/DCI risk, especially to identify age and sex-specific risk groups.


All patients admitted with acute SAH during a 14-year-period ending in 2016 were eligible for this study. The study endpoints were the following: SV requiring spasmolysis, occurrence of DCI in follow-up computed tomography scans and unfavorable outcome at 6 months (modified Rankin scale > 2).


Nine hundred ninety-four patients were included in this study. The majority was female (666; 67%). SV, DCI, and unfavorable outcomes were observed in 21.5, 21.8, and 43.6% of the patients, respectively. Younger age (p < 0.001; OR = 1.03 per year decrease) and female sex (p = 0.025; OR = 1.510) were confirmed as independent predictors of SV. Regarding the sex differences, there were three age groups for SV/DCI risk ≤ 54, 55–74, and ≥ 75 years. Male patients showed earlier decrease in SV risk (at ≥ 55 vs. ≥ 75 years in females). Therefore, SAH females aged between 55 and 74 years were at the highest risk for DCI and unfavorable outcome, as compared to younger/older females (p = 0.001, OR = 1.77/p = 0.001, OR = 1.80). In contrast, their male counterparts did not show these risk alterations (p = 0.445/p = 0.822).


After acute SAH, female and male patients seem to show different age patterns for the risk of SV and DCI. Females aged between 55 and 74 years are at particular risk of vasospasm-related SAH complications, possibly due to onset of menopause.

Clinical trial registration number

DRKS, Unique identifier: DRKS00008749


Symptomatic vasospasm Aneurysm Subarachnoid hemorrhage Delayed cerebral ischemia Age dependency Sex dependency 


CI 95%

Confidence interval 95%


Computed tomography


Delayed cerebral ischemia


Intracerebral hemorrhage


Intraventricular hemorrhage


Modified Rankin scale


Odds ratio


Subarachnoid hemorrhage


Standard deviation


Symptomatic vasospasm


Transcranial Doppler ultrasound


World Federation of Neurosurgical Societies


Compliance with ethical standards

Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organization 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.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Marvin Darkwah Oppong
    • 1
  • Antonella Iannaccone
    • 2
  • Oliver Gembruch
    • 1
  • Daniela Pierscianek
    • 1
  • Mehdi Chihi
    • 1
  • Philipp Dammann
    • 1
  • Angela Köninger
    • 2
  • Oliver Müller
    • 1
  • Michael Forsting
    • 3
  • Ulrich Sure
    • 1
  • Ramazan Jabbarli
    • 1
  1. 1.Department of Neurosurgery, University HospitalUniversity of Duisburg-EssenEssenGermany
  2. 2.Department of Gynecology and Obstetrics, University HospitalUniversity of Duisburg-EssenEssenGermany
  3. 3.Institute for Diagnostic and Interventional Radiology, University HospitalUniversity of Duisburg-EssenEssenGermany

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