Atypical causes of nontraumatic intracranial subarachnoid hemorrhage.
BACKGROUND
To analyze the management and outcome of patients presenting with atypical causes of intracranial subarachnoid hemorrhage (SAH).


METHODS
We performed a review of our last 820 nontraumatic-SAH patients and analyzed the management and outcome of patients where the SAH origin was not a ruptured aneurysm. The Glasgow Outcome Scale (GOS) was used to assess outcome 3 months after event.


RESULTS
Thirty-two patients had atypical causes of SAH. In 15 patients with Hunt and Hess (H&H) scores from 1 to 3 without focal neurological deficit (FND), 8 perimesencephalic non-aneurysmal SAH, 4 blood coagulation disorders, 1 sinus thrombosis, 1 vasculitis, and 1 unknown-origin-SAH (UOS) were diagnosed. Fourteen (93%) of these 15 patients were conservatively treated. In 17 patients with H&H scores from 3 to 5 and FND, 8 tumors, 1 cavernoma, 1 sinus thrombosis, 1 arteriovenous malformation, 1 blood coagulation disorders, 2 UOS, and 3 dural fistulas were diagnosed. Fifteen (88%) of these 17 patients were interventionally treated. The neurological condition 3 months later was good (GOS 4 and 5) in 12 of the 15 cases (80%) admitted with low-H&H scores, as well as in 13 of the 17 cases (76%) admitted with high-H&H scores. Three patients died and four developed a severe disability.


CONCLUSIONS
Patients presenting with atypical causes of SAH and high-H&H scores at admission are likely to harbor an intracranial organic process producing the bleeding. Despite this poor initial condition, their 3-month outcome can be similar to those of patients with low-H&H scores if the origin of the bleeding is properly treated.
Carvi y Nievas
Mario Nazareno
MN
Department of Neurosurgery, Städtische Kliniken, Frankfurt am Main Höchst, PC: 65929, Germany. MCNievas@t-online.de
Archavlis
Eleftherios
E
D001778:Blood Coagulation Disorders / Q000150:complications* / Q000453:epidemiology; D002533:Cerebral Angiography; D015897:Comorbidity; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D009483:Neuropsychological Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012851:Sinus Thrombosis, Intracranial / Q000150:complications* / Q000453:epidemiology; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D014657:Vasculitis / Q000150:complications* / Q000453:epidemiology