Background/Aim. There are several serious complications that can accompany both spontaneous and posttraumatic subarachnoid hemorrhage (SAH) such as the development of intracranial hypertension, hydrocephalus, rebleeding, cerebral hypoxia, cerebral vasospasm, impaired pituitary function, electrolyte imbalance and electrocardiographic (ECG) abnormalities. Although there is a declining trend in mortality, the treatment of SAH and its complications represents a challenge even in imposing neurosurgical centers. Therefore, the aim of the study was to compare some clinical characteristics and complications between spontaneous and posttraumatic SAH. Methods. This retrospective study included 138 patients treated at the Clinic for Neurosurgery in the period from January of 2018 to the January of 2023. There were 71 patients with spontaneous and 67 patients with posttraumatic SAH. Results. A predominance of spontaneous SAH in female and posttraumatic SAH in male patients (p < 0.00001) was found. There was a statistically significant difference in the frequency of hydrocephalus between groups of spontaneous and posttraumatic SAH patients (p = 0.012663). Cerebral vasospasm was significantly more prevalent in patients with spontaneous SAH (p = 0.000091). A statistically significant association was also obtained between the thickness of the coagulum in these two groups (p = 0.000187). Patients with spontaneous SAH were significantly more likely to have a negative T wave (p = 0.000315). Furthermore, there was no statistically significant difference regarding electrolyte imbalance in these two groups of patients with SAH. Conclusion. There were statistically significant differences between gender distribution, the frequency of abnormal ECG findings in the form of a negative T wave, greater coagulum thickness, vasospasm occurrence and a higher rate of hydrocephalus in patients with spontaneous SAH compared to patients with posttraumatic SAH.
Introduction. Parkes-Weber syndrome (PWS) is a complex and rare genetic disease of combined vascular malformations that primarily occur in the extremities and can involve the pelvic blood vessels. In extremely rare cases, the disease is manifested by endocranial and spinal involvement, while the treatment of such patients represents a challenge for neurosurgical centers and requires multidisciplinary approach. Case report. We present the case of a 46-year-old male patient who was admitted to the emergency department due to spontaneous subarachnoid hemorrhage (SAH), moderate flaccid paraparesis and urinary incontinence. Furthermore, the patient was previously diagnosed with PWS, while the genetic evaluation proved the RASA1 gene mutation. He experienced a spontaneous SAH and was hospitalized 26 years ago, while 6 years ago he underwent a right nephrectomy due to multiple hilar aneurysms of the right renal artery and its branches. Digital subtraction angiography of the endocranium was performed, which detected no aneurysmal dilatations or arteriovenous malformations (AVM). The magnetic resonance imaging recorded spinal intradural AVM in the vertebral levels between T12 and L3, which completely filled the dural sac. After the conservative treatment, there was a significant improvement in the patient's neurological and clinical condition. Conclusion. To the best of our knowledge, this is the only case report of a patient with PWS who had a spinal intradural AVM and spontaneous SAH without high-output heart failure, with a history of a previous nephrectomy.
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