S ubarachnoid hemorrhage (SAH) is usually caused by intracranial aneurysm rupture. However, in up to 20% of patients with SAH, results of cerebral angiography, CT, and MRI are negative for aneurysms or other vascular malformations. 2,7,11 More recent data show an increasing number of cases of spontaneous SAH 18,24 as well as nonaneurysmal SAH (NASAH). 15,16 Long-term dipyridamole and warfarin use were associated with an increased risk for aneurysmal SAH (aSAH), whereas the data for low-dose acetylsalicylic acid (LDA) were inconsistent. 10,14,21 Therefore, we analyzed our institutional database for patients suffering from angiography-negative SAH. The aim of the study was to identify risk factors for the increase of NASAH as well as analyze outcome.abbreviatioNs aCP = systemic anticoagulation or antiplatelet agent; aSAH = aneurysmal subarachnoid hemorrhage; CVS = cerebral vasospasm; DCI = delayed cerebral infarction; DSA = digital subtraction angiography; LDA = low-dose acetylsalicylic acid; mRS = modified Rankin Scale; NASAH = nonaneurysmal SAH; NPM = nonperimesencephalic; PM = perimesencephalic; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies.
Patients with NASAH without a Fi3 bleeding pattern had a similar excellent outcome to patients with PM-SAH. Patients with Fi3 had a high risk for early hydrocephalus, CVS, DCI, and an unfavorable outcome, similar to patients with aneurysmal SAH. After multivariate analysis, early hydrocephalus, elderly patients, and Fi3 were identified as negative prognostic factors. Therefore, patients with Fi3 are at risk and need careful clinical observation.
Excluding rolph, only patients with a PM-SAH have a similar QoL at long-term follow-up compared to the standard population. Patients with NPM-SAH have a significantly decreased QoL in long-term follow-up. Furthermore, the Fisher 3 blood pattern group in particular had a significantly worse outcome - at short-term and long-term follow-up. Therefore the NPM-SAH group was stratified into patients with Fisher 3 blood pattern and patients without Fisher 3 in further investigations.
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