Abstract
BackgroundThe predictors of shunt dependency such as amount of subarachnoid blood, acute hydrocephalus (HC), mode of aneurysm repair, clinical grade at admission and cerebro spinal fluid (CSF) drainage in excess of 1500 ml during the 1st week after the subarachnoid hemorrhage (SAH) have been identified as predictors of shunt dependency. Therefore our main objective is to identify predictors of CSF shunt dependency following non-traumatic subarachnoid hemorrhage.MethodsWe performed a retrospective study including patients from January 1st 2012 to September 30th 2014 between 16 and 89 years old and had a non-traumatic subarachnoid hemorrhage in cranial computed tomography (CCT). We excluded patients with the following characteristics: Patients who died 3 days after admittance, lesions in brainstem, previous surgical treatment in another clinic, traumatic brain injury, pregnancy and disability prior to SAH.We performed a descriptive and comparative analysis as well as a logistic regression with the variables that showed a significant difference (p < 0.05). Hence we identified the variables concerning HC after non traumatic SAH and its correlation.ResultsOne hundred and seven clinical files of patients with non-traumatic SAH were analyzed. Twenty one (48%) later underwent shunt treatment. Shunt patients had significantly clinical and corroborated with doppler ultrasonography vasospasmus (p = 0.015), OR = 5.2. The amount of subarachnoidal blood according to modified Fisher grade was (p = 0.008) OR = 10.9. Endovascularly treated patients were less often shunted as compared with those undergoing surgical aneurysm repair (p = 0.004).ConclusionVasospasmus and a large amount of ventricular blood seem to be a predictor concerning hydrocephalus after non-traumatic SAH. Hence according to our results the presence of these two variables could alert the treating physician in the decision whether an early shunt implantation < 7 days after SAH should be necessary.
Highlights
The predictors of shunt dependency such as amount of subarachnoid blood, acute hydrocephalus (HC), mode of aneurysm repair, clinical grade at admission and cerebro spinal fluid (CSF) drainage in excess of 1500 ml during the 1st week after the subarachnoid hemorrhage (SAH) have been identified as predictors of shunt dependency
While acute HC is present in 15-87% [2,3,4,5,6], chronic HC has been reported in 9-64% of SAH [7,8,9,10,11,12,13]
The predictors of shunt dependency such as amount of subarachnoid blood, acute HC, mode of aneurysm repair, clinical grade at admission and CSF drainage in excess of 1500 ml during the 1st week after the ictus have been identified as predictors of shunt dependency
Summary
The predictors of shunt dependency such as amount of subarachnoid blood, acute hydrocephalus (HC), mode of aneurysm repair, clinical grade at admission and cerebro spinal fluid (CSF) drainage in excess of 1500 ml during the 1st week after the subarachnoid hemorrhage (SAH) have been identified as predictors of shunt dependency. The predictors of shunt dependency such as amount of subarachnoid blood, acute HC, mode of aneurysm repair, clinical grade at admission and CSF drainage in excess of 1500 ml during the 1st week after the ictus have been identified as predictors of shunt dependency. There are discrepancies in these predictor factors about their influence in patients being shunted [3, 7, 9, 12, 13, 19, 20] Taking in count these discrepancies our main objective was to confirm and/or to reveal, until now, not taken in count predictor factors in shunt dependency following spontaneous subarachnoid hemorrhage
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