Prognosis and prognostic factors for unexplained subarachnoid hemorrhage: Review of 84 cases

Faruk Ildan, Metin Tuna, Tahsin Erman, A. Iskender Göçer, Erdal Çetinalp, Refik Burgut, Daniel L. Barrow, Matti Vapalahti, Engelbert Knosp, H. Hunt Batjer

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: We conducted a retrospective study to investigate the prognosis, possible prognostic factors, and long-term natural history of subarachnoid hemorrhage of unexplained cause. METHODS: This report contains a retrospective analysis of data for 84 patients with subarachnoid hemorrhage of unknown cause who were monitored for 1 month to 9.5 years, with an average follow-up period of 5.6 years. We evaluated the associations between computed tomographic (CT) scan features, clinical grade, loss of consciousness during hemorrhage, ventricular ratio, angiographic spasm, complications (such as death resulting from ischemia, early rebleeding, late rebleeding, epilepsy, hydrocephalus, and fixed ischemic deficits), and outcomes, using a nonparametric, two-sample, Kolmogorov-Smirnov test. The X2 test was used to test the independence of two categorical variables. RESULTS: CT class exhibited a significant association with clinical grade (γ = 0.865, P = 0.006), loss of consciousness during hemorrhage (γ = 0.69, P = 0.001), and ventricular ratio (γ = 0.8175, P = 0.01) but a nonsignificant association with angiographic vasospasm (γ = 0.21, P = 0.2). Death resulting from ischemic complications and fixed ischemic deficits were strongly associated with clinical grade (P = 0.003 and P = 0.008, respectively) but weakly associated with CT class (P = 0.06 and P = 0.084, respectively). Angiographic vasospasm was strongly associated only with fixed ischemic deficits among complications (P = 0.001). Clinical outcome was strongly positively associated with CT class (γ = 0.685, P = 0.001), clinical grade (γ = 0.81, P = 0.001), and ventricular ratio (γ = 0.57, P = 0.002) but weakly positively associated with loss of consciousness during hemorrhage (γ = 0.459, P = 0.0487) and angiographic vasospasm (γ = 0.48, P = 0.04). CONCLUSION: Our study confirms earlier studies reporting a good prognosis for survival, but it does not confirm the earlier statements regarding low morbidity rates. Although clinical grade and the presence and amount of subarachnoid blood on CT scans are the major prognostic factors related to the incidence of ischemic complications, clinical grade and CT class are also the main parameters, with ventricular ratio, indicating clinical outcomes for patients with subarachnoid hemorrhage of unknown cause.

Original languageEnglish (US)
Pages (from-to)1015-1025
Number of pages11
JournalNeurosurgery
Volume50
Issue number5
DOIs
StatePublished - May 1 2002

Fingerprint

Subarachnoid Hemorrhage
Unconsciousness
Hemorrhage
Spasm
Hydrocephalus
Nonparametric Statistics
Epilepsy
Ischemia
Retrospective Studies
Morbidity
Survival
Incidence

Keywords

  • Prognosis
  • Prognostic factor
  • Subarachnoid hemorrhage
  • Unknown cause

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Prognosis and prognostic factors for unexplained subarachnoid hemorrhage : Review of 84 cases. / Ildan, Faruk; Tuna, Metin; Erman, Tahsin; Göçer, A. Iskender; Çetinalp, Erdal; Burgut, Refik; Barrow, Daniel L.; Vapalahti, Matti; Knosp, Engelbert; Batjer, H. Hunt.

In: Neurosurgery, Vol. 50, No. 5, 01.05.2002, p. 1015-1025.

Research output: Contribution to journalArticle

Ildan, F, Tuna, M, Erman, T, Göçer, AI, Çetinalp, E, Burgut, R, Barrow, DL, Vapalahti, M, Knosp, E & Batjer, HH 2002, 'Prognosis and prognostic factors for unexplained subarachnoid hemorrhage: Review of 84 cases', Neurosurgery, vol. 50, no. 5, pp. 1015-1025. https://doi.org/10.1097/00006123-200205000-00015
Ildan, Faruk ; Tuna, Metin ; Erman, Tahsin ; Göçer, A. Iskender ; Çetinalp, Erdal ; Burgut, Refik ; Barrow, Daniel L. ; Vapalahti, Matti ; Knosp, Engelbert ; Batjer, H. Hunt. / Prognosis and prognostic factors for unexplained subarachnoid hemorrhage : Review of 84 cases. In: Neurosurgery. 2002 ; Vol. 50, No. 5. pp. 1015-1025.
@article{2b98363b830b48c59626b2fdd91ce82b,
title = "Prognosis and prognostic factors for unexplained subarachnoid hemorrhage: Review of 84 cases",
abstract = "OBJECTIVE: We conducted a retrospective study to investigate the prognosis, possible prognostic factors, and long-term natural history of subarachnoid hemorrhage of unexplained cause. METHODS: This report contains a retrospective analysis of data for 84 patients with subarachnoid hemorrhage of unknown cause who were monitored for 1 month to 9.5 years, with an average follow-up period of 5.6 years. We evaluated the associations between computed tomographic (CT) scan features, clinical grade, loss of consciousness during hemorrhage, ventricular ratio, angiographic spasm, complications (such as death resulting from ischemia, early rebleeding, late rebleeding, epilepsy, hydrocephalus, and fixed ischemic deficits), and outcomes, using a nonparametric, two-sample, Kolmogorov-Smirnov test. The X2 test was used to test the independence of two categorical variables. RESULTS: CT class exhibited a significant association with clinical grade (γ = 0.865, P = 0.006), loss of consciousness during hemorrhage (γ = 0.69, P = 0.001), and ventricular ratio (γ = 0.8175, P = 0.01) but a nonsignificant association with angiographic vasospasm (γ = 0.21, P = 0.2). Death resulting from ischemic complications and fixed ischemic deficits were strongly associated with clinical grade (P = 0.003 and P = 0.008, respectively) but weakly associated with CT class (P = 0.06 and P = 0.084, respectively). Angiographic vasospasm was strongly associated only with fixed ischemic deficits among complications (P = 0.001). Clinical outcome was strongly positively associated with CT class (γ = 0.685, P = 0.001), clinical grade (γ = 0.81, P = 0.001), and ventricular ratio (γ = 0.57, P = 0.002) but weakly positively associated with loss of consciousness during hemorrhage (γ = 0.459, P = 0.0487) and angiographic vasospasm (γ = 0.48, P = 0.04). CONCLUSION: Our study confirms earlier studies reporting a good prognosis for survival, but it does not confirm the earlier statements regarding low morbidity rates. Although clinical grade and the presence and amount of subarachnoid blood on CT scans are the major prognostic factors related to the incidence of ischemic complications, clinical grade and CT class are also the main parameters, with ventricular ratio, indicating clinical outcomes for patients with subarachnoid hemorrhage of unknown cause.",
keywords = "Prognosis, Prognostic factor, Subarachnoid hemorrhage, Unknown cause",
author = "Faruk Ildan and Metin Tuna and Tahsin Erman and G{\"o}{\cc}er, {A. Iskender} and Erdal {\cC}etinalp and Refik Burgut and Barrow, {Daniel L.} and Matti Vapalahti and Engelbert Knosp and Batjer, {H. Hunt}",
year = "2002",
month = "5",
day = "1",
doi = "10.1097/00006123-200205000-00015",
language = "English (US)",
volume = "50",
pages = "1015--1025",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Prognosis and prognostic factors for unexplained subarachnoid hemorrhage

T2 - Review of 84 cases

AU - Ildan, Faruk

AU - Tuna, Metin

AU - Erman, Tahsin

AU - Göçer, A. Iskender

AU - Çetinalp, Erdal

AU - Burgut, Refik

AU - Barrow, Daniel L.

AU - Vapalahti, Matti

AU - Knosp, Engelbert

AU - Batjer, H. Hunt

PY - 2002/5/1

Y1 - 2002/5/1

N2 - OBJECTIVE: We conducted a retrospective study to investigate the prognosis, possible prognostic factors, and long-term natural history of subarachnoid hemorrhage of unexplained cause. METHODS: This report contains a retrospective analysis of data for 84 patients with subarachnoid hemorrhage of unknown cause who were monitored for 1 month to 9.5 years, with an average follow-up period of 5.6 years. We evaluated the associations between computed tomographic (CT) scan features, clinical grade, loss of consciousness during hemorrhage, ventricular ratio, angiographic spasm, complications (such as death resulting from ischemia, early rebleeding, late rebleeding, epilepsy, hydrocephalus, and fixed ischemic deficits), and outcomes, using a nonparametric, two-sample, Kolmogorov-Smirnov test. The X2 test was used to test the independence of two categorical variables. RESULTS: CT class exhibited a significant association with clinical grade (γ = 0.865, P = 0.006), loss of consciousness during hemorrhage (γ = 0.69, P = 0.001), and ventricular ratio (γ = 0.8175, P = 0.01) but a nonsignificant association with angiographic vasospasm (γ = 0.21, P = 0.2). Death resulting from ischemic complications and fixed ischemic deficits were strongly associated with clinical grade (P = 0.003 and P = 0.008, respectively) but weakly associated with CT class (P = 0.06 and P = 0.084, respectively). Angiographic vasospasm was strongly associated only with fixed ischemic deficits among complications (P = 0.001). Clinical outcome was strongly positively associated with CT class (γ = 0.685, P = 0.001), clinical grade (γ = 0.81, P = 0.001), and ventricular ratio (γ = 0.57, P = 0.002) but weakly positively associated with loss of consciousness during hemorrhage (γ = 0.459, P = 0.0487) and angiographic vasospasm (γ = 0.48, P = 0.04). CONCLUSION: Our study confirms earlier studies reporting a good prognosis for survival, but it does not confirm the earlier statements regarding low morbidity rates. Although clinical grade and the presence and amount of subarachnoid blood on CT scans are the major prognostic factors related to the incidence of ischemic complications, clinical grade and CT class are also the main parameters, with ventricular ratio, indicating clinical outcomes for patients with subarachnoid hemorrhage of unknown cause.

AB - OBJECTIVE: We conducted a retrospective study to investigate the prognosis, possible prognostic factors, and long-term natural history of subarachnoid hemorrhage of unexplained cause. METHODS: This report contains a retrospective analysis of data for 84 patients with subarachnoid hemorrhage of unknown cause who were monitored for 1 month to 9.5 years, with an average follow-up period of 5.6 years. We evaluated the associations between computed tomographic (CT) scan features, clinical grade, loss of consciousness during hemorrhage, ventricular ratio, angiographic spasm, complications (such as death resulting from ischemia, early rebleeding, late rebleeding, epilepsy, hydrocephalus, and fixed ischemic deficits), and outcomes, using a nonparametric, two-sample, Kolmogorov-Smirnov test. The X2 test was used to test the independence of two categorical variables. RESULTS: CT class exhibited a significant association with clinical grade (γ = 0.865, P = 0.006), loss of consciousness during hemorrhage (γ = 0.69, P = 0.001), and ventricular ratio (γ = 0.8175, P = 0.01) but a nonsignificant association with angiographic vasospasm (γ = 0.21, P = 0.2). Death resulting from ischemic complications and fixed ischemic deficits were strongly associated with clinical grade (P = 0.003 and P = 0.008, respectively) but weakly associated with CT class (P = 0.06 and P = 0.084, respectively). Angiographic vasospasm was strongly associated only with fixed ischemic deficits among complications (P = 0.001). Clinical outcome was strongly positively associated with CT class (γ = 0.685, P = 0.001), clinical grade (γ = 0.81, P = 0.001), and ventricular ratio (γ = 0.57, P = 0.002) but weakly positively associated with loss of consciousness during hemorrhage (γ = 0.459, P = 0.0487) and angiographic vasospasm (γ = 0.48, P = 0.04). CONCLUSION: Our study confirms earlier studies reporting a good prognosis for survival, but it does not confirm the earlier statements regarding low morbidity rates. Although clinical grade and the presence and amount of subarachnoid blood on CT scans are the major prognostic factors related to the incidence of ischemic complications, clinical grade and CT class are also the main parameters, with ventricular ratio, indicating clinical outcomes for patients with subarachnoid hemorrhage of unknown cause.

KW - Prognosis

KW - Prognostic factor

KW - Subarachnoid hemorrhage

KW - Unknown cause

UR - http://www.scopus.com/inward/record.url?scp=0036590011&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036590011&partnerID=8YFLogxK

U2 - 10.1097/00006123-200205000-00015

DO - 10.1097/00006123-200205000-00015

M3 - Article

C2 - 11950404

AN - SCOPUS:0036590011

VL - 50

SP - 1015

EP - 1025

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -