Symptomatic vasospasm after subarachnoid hemorrhage: study of 186 cases

Abstract

To identify the risk factors associated with symptomatic vasospasm after aneurysmal subarachnoid hemorrhage (SAH). The clinical data of 186 cases with SAH verified by radiology and lumbar puncture were reviewed retrospectively. Fifty-five of the 186 patients (29.6%) developed symptomatic vasospasm. The incidence of symptomatic vasospasm was significantly higher in the patients of Fisher grade III than in those of Fisher grade I and Fisher grade II, in the patients in poor clinical status at admission the in those in better clinical status, and in the patients with repeated reoccurrence of SAH then in those without reoccurrence (all P < 0.01). Sex, age, treatment modality, and use of antifibrinolytic drugs (AFD) did not influence the development of symptomatic vasospasm (all P > 0.05). Multivariate analysis showed that Fisher grade III [odds ratio (OR) 2.549, 95% confidence interval (CI) 1.406 - 4.517], poor clinical status at admission (OR 2.342, 95% CI 1.320 - 4.159) and repeated reoccurrence of SAH (OR 2.492, 95% CI 1.394 approximately 4.448) were associated with the increased risk of symptomatic vasospasm. Fisher grade III, poor clinical status at admission and repeated reoccurrence of SAH are significant independent risk factors of symptomatic vasospasm. The presence of symptomatic vasospasm can be independently predicted by the amount of subarachnoid hemorrhage, clinical status at admission, and times of SAH.