title: Fatal subarachnoid hemorrhage following ischemia in vertebrobasilar dolichoectasia.
abstract: Vertebrobasilar dolichoectasia (VBD) is a chronic disorder with various cerebrovascular and compressive manifestations, involving subarachnoid hemorrhage (SAH). Occurrence of SAH shortly after worsening of clinical VBD symptoms has occasionally been reported. The goal of the study was to examine this association, in particular its pathophysiology, clinical precursor signs, time course, and outcome.To this end, in a retrospective multicenter study, we analyzed 20 patients with VBD and SAH in regard to preceding clinical symptoms, presence of vertebrobasilar thrombosis and ischemia, outcome and neuropathological correlates.Median age of the 7 female and 13 male patients was 70 years (interquartile range [IQR] 18.3 years). Fourteen patients (70%) presented with new or acutely worsening posterior fossa signs at a median of 3 days prior to SAH (IQR 2, range 0.5-14). A thrombus within the VBD was detected in 12 patients (60%). Thrombus formation was associated with clinical deterioration (χ = 4.38, P = 0.04) and ponto-cerebellar ischemia (χ = 8.09, P = 0.005). During follow-up after SAH, 13 patients (65%) died, after a median survival time of 24 hours (IQR 66.2, range 2-264 hours), with a significant association between proven ponto-cerebellar ischemia and case fatality (χ = 6.24, P = 0.01).The data establish an association between clinical deterioration in patients with VBD, vertebrobasilar ischemia, and subsequent SAH. Antithrombotic treatment after deterioration appears controversial and SAH outcome is frequently fatal. Our data also indicate a short window of 3 days that may allow for evaluating interventional treatment, preferably within randomized trials.
authors.affiliation: Stroke Center, Service de Neurologie, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland Department of Interventional Neurology and Stroke, Institute of Neurosciences, Saket City Hospital, New Delhi, India Service de Neurologie, Département des Neurosciences Cliniques, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland Service de Neurologie, Fondation Hopale, Berck-sur-Mer, France Service de Pathologie Clinique, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland The Comprehensive Stroke Center, Tufts University Medical Center, Boston, MA Servizio di Neurologia, Ospedale Regionale di Lugano, Lugano Neurologische Klinik, Kantonsspital Aarau, Aarau, Switzerland Stroke Unit and Division of Internal and Cardiovascular Medicine, Ospedale Santa Maria della Misericordia, Perugia, Italy Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Arseny A
authors.initials: AA
authors.lastname: Sokolov
authors.forename: Shakir
authors.initials: S
authors.lastname: Husain
authors.forename: Roman
authors.initials: R
authors.lastname: Sztajzel
authors.forename: Alexandre
authors.initials: A
authors.lastname: Croquelois
authors.forename: Johannes A
authors.initials: JA
authors.lastname: Lobrinus
authors.forename: David
authors.initials: D
authors.lastname: Thaler
authors.forename: Claudio
authors.initials: C
authors.lastname: Städler
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Hungerbühler
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
authors.forename: Gabriel J
authors.initials: GJ
authors.lastname: Rinkel
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology* / Q000401:mortality* / Q000503:physiopathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000503:physiopathology