title: Identification of specific age groups with a high risk for developing cerebral vasospasm after aneurysmal subarachnoid hemorrhage.
abstract: The impact of age on the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) is a matter of ongoing discussion. The aim of this study was to identify age groups with a higher risk for developing vasospasm, delayed ischemic neurological deficit (DIND), or delayed infarction (DI) and to identify a cut-off age for a better risk stratification. We defined six age groups (<30, 30-39, 40-49, 50-59, 60-69, and >70 years). ROC analysis was performed to determine a cutoff age with the highest positive predictive value (PPV) for developing vasospasm, defined as a blood-flow-velocity-increase >120 cm/s in transcranial-Doppler-sonography (TCD). Multivariate binary-logistic-regression-analysis was then performed to evaluate differences in the incidence of cerebral vasospasm, DIND, and DI among the different age groups. A total of 753 patients were included in the study. The highest incidence (70 %) of TCD-vasospasm was found in patients between 30 and 39 years of age. The cutoff age with the highest PPV (65 %) for developing TCD-vasospasm was 38 years. Multivariate analysis revealed that age <38 years (OR 3.6; CI 95 % 2.1-6.1; p < 0.001) best predicted vasospasm, followed by the need for cerebrospinal fluid drainage (OR 1.5; CI 95 % 1.0-2.3; p = 0.04). However, lower age did not correlate with higher rates of DIND or infarcts. The overall vasospasm-incidence after aSAH is age-dependent and highest in the age group <38 years. Surprisingly, the higher incidence in the younger age group does not translate into a higher rate of DIND/DI. This finding may hint towards age-related biological factors influencing the association between arterial narrowing and cerebral ischemia.
authors.affiliation: Department of Neurosurgery, Georg August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany. vesna.malinova@gmail.com.
authors.forename: Vesna
authors.initials: V
authors.lastname: Malinova
authors.affiliation: Department of Neurosurgery, Georg August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Bawarjan
authors.initials: B
authors.lastname: Schatlo
authors.affiliation: Department of Neurosurgery, Georg August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Voit
authors.affiliation: Department of Neurosurgery, Georg August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Patricia
authors.initials: P
authors.lastname: Suntheim
authors.affiliation: Department of Neurosurgery, Georg August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.|Department of Neurosurgery, RWTH University, Aachen, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
authors.affiliation: Department of Neurosurgery, Georg August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
authors.forename: Dorothee
authors.initials: D
authors.lastname: Mielke
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000453:epidemiology; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000453:epidemiology*; D020301:Vasospasm, Intracranial / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Aneurysmal subarachnoid hemorrhage; Cerebral vasospasm; Transcranial Doppler sonography