Misdiagnosis of acute subarachnoid hemorrhage in the era of multimodal diagnostic options

Doukas, Alexandros; Barth, Harald; Petridis, K. Athanasios; Mehdorn, Maximilian

doi:10.1016/j.ajem.2019.03.001

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…However, sometimes early treatment might not be possible due to several reasons but mainly due to delayed presentation to hospital, most frequently the case in low grade aSAH [18][19][20]. Treatment during CVS phase has been subject to controversy; however, only few data exist [21][22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

“…There has been a change in treatment paradigm of ruptured intracranial aneurysm over the last decade with currently favoring early or even ultra-early occlusion [ 13 – 17 ]. However, sometimes early treatment might not be possible due to several reasons but mainly due to delayed presentation to hospital, most frequently the case in low grade aSAH [ 18 – 20 ]. Treatment during CVS phase has been subject to controversy; however, only few data exist [ 21 – 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage

et al. 2022

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Background Aneurysm treatment during cerebral vasospasm (CVS) phase is frequently considered as particularly dangerous, mainly because of the risk of cerebral infarct. Objective We aimed to evaluate the risk of aneurysmal subarachnoid haemorrhage (aSAH)-specific complications and functional outcome in patients treated during CVS phase. Methods We retrospectively analysed a large, retro- and prospectively collected database of aSAH patients admitted to our department between March 2006 and March 2020. We conducted a uni- and multivariable logistic regression analysis to evaluate influencing factors on rebleeding, cerebral infarct, Glasgow Outcome Score (GOS) at discharge and mortality and assessed the rate of angiographic vasospasm on admission. Results We included 853 patients. The majority of patients were female (66.6%), mean age was 57.3 years. Out of 853 included patients, 92 (10.8%) were treated during CVS phase, 312 (36.6%) underwent clipping and 541 (63.4%) endovascular treatment. Treatment during CVS phase was significantly associated with cerebral infarct in the multivariable logistic regression analysis, unrelated to the nature of intervention (OR 2.42, 1.29–4.54 95% CI p-value = 0.006). However, patients treated during CVS phase did not have increased risk of unfavourable outcome by GOS on discharge. In addition, they did not have a higher rate of rebleeding or mortality. Conclusions Treatment during CVS phase was significantly associated with a higher rate of cerebral infarct as confirmed by imaging. This did not reflect on GOS on discharge, rebleeding, or mortality. Aneurysm treatment during CVS phase is relatively safe and should not be postponed due to the risk of rebleeding and subsequent devastating deterioration.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage

et al. 2022

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“…Delay in hospital admission is most frequently caused by the need transfer a patient from another hospital. This can be due to initial misdiagnosis, reported to be as high as 51% [8][9][10] . Delay in correct diagnosis has markedly decreased as shown in previous studies 11 .…”

Section: Introductionmentioning

confidence: 99%

Duration between aneurysm rupture and treatment - association with outcome in aneurysmal subarachnoid haemorrhage

Hostettler¹,

Lange²,

Schwendinger³

et al. 2022

Preprint

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Introduction: Timely treatment of aneurysmal subarachnoid haemorrhage (aSAH) is key to prevent further rupture and poor outcome. We evaluated complications and outcome adjusting for time from haemorrhage to treatment. Methods: Retrospective analysis of aSAH patients admitted between 2006 and 2020. Data was collected using standardized case report forms. We compared risk factors using multivariable logistic regression. Results: We included 853 patients, 698 (81.8%) were treated within 24 hours. Patients with higher Hunt and Hess grades were admitted and treated significantly faster than those with lower grades (overall p-value<0.001). Fifteen patients (1.8%) rebled before intervention. In the multivariable logistic analysis adjusting for timing, Barrow Neurological Institute score and intracerebral haemorrhage were significantly associated with rebleeding (overall p-value 0.006; OR 3.12, 95%CI 1.09-8.92, p=0.03, respectively). Treatment >24 hours was associated with higher mortality and cerebral infarction in lower grades aSAH (OR 3.13, 1.02-9.58 95%CI, p-value=0.05; OR 7.69, 2.44-25.00, p-value<0.001, respectively). Conclusion: Treatment >24 hours after rupture is associated with higher mortality and cerebral infarction rates in lower grades aSAH. Delay in treatment with consequently higher complication rates primarily affects patients with lower grade aSAH. Patients with lower grade aSAH ought to be treated with the same urgency as higher-grade aSAH.

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“…Rezidivblutungen bei einem unbehandelten Aneurysma gehören mit ca. 40% zu den häufigsten Komplikationen einer SAB (Coppadoro und Citerio 2011;Doukas et al 2019). Das Risiko einer Rezidivblutung ist in den ersten Tagen am höchsten.…”

Section: Rezidivblutungenunclassified

“…Die Prognose ist für betroffene Patienten sehr schlecht, da ca. 80% der Patienten an der erneuten Blutung versterben oder eine schwere Behinderung davon tragen (Dupont et al 2010;Zhao et al 2016;Doukas et al 2019).…”

Section: Rezidivblutungenunclassified

Unterschiede im intensivmedizinischen Management bei akuter aneurysmatischer Subarachnoidalblutung: eine Umfragestudie

Clara¹

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Misdiagnosis of acute subarachnoid hemorrhage in the era of multimodal diagnostic options

Cited by 11 publications

References 19 publications

Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage

Treatment during cerebral vasospasm phase—complication association and outcome in aneurysmal subarachnoid haemorrhage

Duration between aneurysm rupture and treatment - association with outcome in aneurysmal subarachnoid haemorrhage

Unterschiede im intensivmedizinischen Management bei akuter aneurysmatischer Subarachnoidalblutung: eine Umfragestudie

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