Vergleichende Risikoprofilanalyse zwischen perimesenzephaler und aneurysmatischer Subarachnoidalblutung: Auswirkungen von Komorbiditäten auf das Patientenoutcome

Aneurysmal subarachnoid hemorrhage (aSAH) and non-traumatic non-aneurysmal SAH (pSAH) represent two distinct and complex forms of cerebral bleeding. This study provides a comprehensive comparison between aSAH and pSAH, focusing on patient outcomes, complication rates, and the impact of comorbidities on these parameters.

We retrospectively analyzed clinical data from a large cohort of pSAH (n=188) and aSAH patients (n=458), emphasizing complication rates (hydrocephalus and vasospasms) and their pre-existing health conditions such as cardiovascular diseases, hypertension and diabetes with their impact on patients outcome.

The median age of aSAH patients was 54.9 years, significantly younger than pSAH patients, who had a median age of 57.2 years (p=.026). In the aSAH patient group, men constituted 35.6%, whereas in the pSAH group, a higher proportion of 57.4% were male (p<.001). In pSAH patients it was found that 40.8% had hypertension, compared to 48.4% in aSAH patients (p=.047). Diabetes was present in 17% of pSAH patients, but only 7% in aSAH patients (p<.001). Coronary heart disease (CHD) was observed in 1.1% of aSAH patients and 3.7% of pSAH patients (p=.047). Lower Glasgow Outcome Scale (GOSE) values of 1-4 indicated a significantly worse outcome in 56% of aSAH patients, with only 22.9% of pSAH patients (p<0.001). Nicotine abuse and hypertension had a positive effect on improved outcomes in aSAH patients, but this effect was not observed in pSAH patients (p=.048 and p=.002). The occurrence of hydrocephalus was associated with poor outcomes in both groups (p<0.001), but was significantly more common in aSAH patients (73.6%) compared to pSAH patients (16.5%) (p<0.001). A similar pattern was seen for the occurrence of vasospasms with an incidence of 32.8% in aSAH patients and 19.7% in pSAH patients (p<0.042). These results were also significantly reflected in the modified Rankin Scale and the World Federation of Neurosurgical Societies grading system.

The pSAH and aSAH patient populations differ significantly in gender and age. The older pSAH patients have more comorbidities, but generally better outcomes and lower rates of hydrocephalus and vasospasm. In contrast, positive effects of hypertension and nicotine abuse on outcomes were observed in aSAH patients but not in pSAH patients.