Journal article
Intraventricular extension of an aneurysmal subarachnoid hemorrhage is an independent predictor of a worse functional outcome
Clinical neurology and neurosurgery, Vol.170, pp.67-72
07/2018
DOI: 10.1016/j.clineuro.2018.04.032
PMID: 29730271
Abstract
•Patients with IVH had a higher rate of anterograde amnesia and lower rate of mRS0-2.•Patients with IVH had a higher rate of cognitive impairment.•Increasing IVH grade was an independent predictor of poor cognitive outcome.•Worse HHG and IVH grade 2–4 were independent predictors of amnesia.
The objective of this study is to determine the impact of intraventricular hemorrhage (IVH) on the cognitive prognosis of subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm, independent of the presence of intraparenchymal hemorrhage, hydrocephalus or vasospasm.
A Retrospective review of a prospectively collected database of patients with aneurysmal SAH from July 2009 to November 2016 was performed. Patients were included if they had a saccular aneurysm with a Hunt-Hess grade (HHG) 1–3. Those who underwent craniectomy/clipping and those with vasospasm were excluded. Patients with IVH were grouped into 5 groups depending on the blood distribution in the ventricles. Functional outcomes studied were modified Rankin score (mRS) 0–2, cognitive impairment and memory impairment, and the presence of amnesia to the event. A univariate followed by a multivariate analysis ware performed.
A total of 443 patients were identified and 124 patients met the criterion. There were no significant differences in the proportion of patients with mRS of 0–2 between patients with IVH and those without IVH but with EVD (external ventricular drain). There was a higher proportion of cognitive deficits in patients with IVH (71.95%), compared to those without (31.58%; p = 0.01). Patients with IVH had a higher rate of anterograde amnesia (100% vs. 4.3% p < 0.0001), lower rate of mRS 0–2 (78% vs 100% p < 0.001), and higher rate of cognitive impairment (71.9% vs. 13% p < 0.0001) compared with those who did not require an EVD. Grade 3 and grade 4 were shown to have lower rate of patients with mRS 0–2 and a higher rate of cognitive impairment.
In multivariate analysis, independent predictors of cognitive and memory impairment were increasing HHG (OR = 155.33; P < 0.01), ACOM/A1/ACA/anterior choroidal aneurysms, (OR = 5.24; P = 0.04), increasing Fischer scale (OR = 6.93; P = 0.01), and increasing IVH grade (OR = 6.9; P = 0.01). Only worse HHG (OR = 2704.22; P = 0.01) and IVH grade 2–4 were associated (perfect predictor, OR cannot be extracted) with anterograde amnesia.
IVH is an independent prognosticator of SAH cognitive outcomes. The effect of IVH drainage and other intraventricular therapies on SAH course is an attractive topic for further investigation.
Details
- Title: Subtitle
- Intraventricular extension of an aneurysmal subarachnoid hemorrhage is an independent predictor of a worse functional outcome
- Creators
- Mario Zanaty - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesDaichi Nakagawa - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesRobert M Starke - Department of Neurosurgery and Radiology, University of Miami, Miami, Fl, United StatesEnrique C Leira - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesEdgar A Samaniego - Department of Neurology and Neurointerventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesWaldo R Guerrero - Department of Neurology and Neurointerventional Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesJames Torner - Department of Epidemiology, University of Iowa College of Public Health, United StatesYasunori Nagahama - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesOlatilewa Awe - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesJeremy Greenlee - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesJoseph S Hudson - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesLauren Allan - Department of General Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesReem Elwy - Department of Neurosurgery, Doki, Giza, EgyptNohra Chalouhi - Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United StatesPascal Jabbour - Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, United StatesRoyce Woodroffe - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesAnthony Piscopo - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United StatesDavid Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
- Resource Type
- Journal article
- Publication Details
- Clinical neurology and neurosurgery, Vol.170, pp.67-72
- DOI
- 10.1016/j.clineuro.2018.04.032
- PMID
- 29730271
- NLM abbreviation
- Clin Neurol Neurosurg
- ISSN
- 0303-8467
- eISSN
- 1872-6968
- Publisher
- Elsevier B.V
- Language
- English
- Date published
- 07/2018
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Stead Family Department of Pediatrics; Epidemiology; Iowa Neuroscience Institute; Surgery; Injury Prevention Research Center; Neurosurgery; Otolaryngology
- Record Identifier
- 9983996057502771
Metrics
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