Abstract Details

Title Comparing the Outcomes of Patients with Idiopathic Subarachnoid Hemorrhage by Three Distinct Perimesencephalic Bleed Patterns

Topic General Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-018

Objective To divide perimesencephalic hemorrhages (PSAHs) into three distinct bleed groups and compare clinical courses and outcomes.

Background Most studies on idiopathic SAH focus on comparing PSAHs to aneurysmal SAHs.

Design/Methods We included adult patients (≥18) with an angiography-negative, non-traumatic SAH treated at a comprehensive stroke center (1/2015-5/2018). We excluded patients with known etiologies and convexity bleeds (N=41). Patients were categorized by bleed location on CTA: Peri-1: focal prepontine; Peri-2: pan-suprasellar cisterns; Peri-3: pan-suprasellar cisterns + sylvian fissures + intraventricular extension. Outcomes were cerebral ischemia (CI), hydrocephalus and severity, neuro critical care length of stay (NCCU LOS), and hospital LOS.

Results Of the 43 patients included in the study, 37% were Peri-1, 28% were Peri-2, and 35% were Peri-3. A majority were male (67%), with a median (IQR) age of 57 (44-63), and often presented with a headache (93%), nausea (72%), and a Hunt and Hess score of 1-3 (93%). Patients presenting with lethargy (6% vs. 17% vs. 67% p=0.006) and a modified Fisher score of 3 vs. 4 (100% vs. 92% vs. 33% p<0.001) were significantly different between groups in Peri-1-3, respectively. A history of hypertension (19% vs. 25% vs. 60% p=0.04) and mean (SD) days on nimodipine treatment (9.1 (4.8) vs. 11.9 (7.3) vs. 15.1 (5.9), p=0.03) were significantly different between groups. Six (14%) patients had severe hydrocephalus and eight (19%) had CI. Median NCCU (7 vs. 8 vs. 11, p=0.01) and hospital LOS (8.5 vs. 11.5 vs. 14, p=0.002), and proportion with hydrocephalus (6% vs. 25% vs. 53%, p=0.01), were significantly different between groups.

Conclusions Our study suggests that patients with the best outcomes were those in Peri-1, followed by Peri-2, and then Peri-3. Because there are no clear risk factors for PSAHs, understanding differences by bleed patterns may help tailor better treatment strategies for this population.

Authors/Disclosures
Jeffrey C. Wagner, MD (Carepoint HC) PRESENTER	Dr. Wagner has nothing to disclose.
	No disclosure on file
Russell E. Bartt, MD, FAAN (Blue Sky Neurosciences)	Dr. Bartt has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Alicia E. Bennett, DO (CarePoint HC)	Dr. Bennett has nothing to disclose.
Alessandro Orlando, MPH (Trauma Research)	No disclosure on file
Benjamin Atchie	No disclosure on file

��ɫ��

��ɫ��