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Browsing by Author "Achrén, Alexander"

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  • Achrén, Alexander; Raj, Rahul; Siironen, Jari; Laakso, Aki; Marjamaa, Johan (2021)
    Background: Spontaneous angiogram negative subarachnoid hemorrhage (SAH) is considered a benign illness with little of the aneurysmal SAH-related complications. We describe the clinical course, SAH-related complications and outcome of patients with angiogram negative SAH. Methods: We retrospectively reviewed all adult patients admitted to a neurosurgical intensive care unit during 2004–2018 due to spontaneous angiogram negative SAH. Our primary outcome was a dichotomized Glasgow Outcome Scale at three months. We assessed factors that associated with outcome using multivariable logistic regression analysis. Results: Of included 108 patients, 84% had a favorable outcome and mortality was 5% within oneyear. Median age was 58 years, 51% were female, and 93% had a low grade SAH (World Federation of Neurosurgical Societies grading I-III). The median number of angiograms performed per patient was two. Thirty per cent of patients showed radiological signs of acute hydrocephalus, 28% were acutely treated with an external ventricular drain, 13% received active vasospasm treatment and 17% received a permanent shunt. In the multivariable logistic regression model, only acute hydrocephalus associated with unfavorable outcome (odds ratio 4.05, 95% confidence interval 1.05–15.73). Two patients had a new bleeding episode. One of those patients had already suffered a spontaneous angiogram negative SAH prior to the current hospitalization. Conclusion: SAH-related complications such as hydrocephalus and vasospasm are common after angiogram negative SAH. Still, most patients had a favorable outcome. Only acute hydrocephalus was associated with unfavorable outcome. Our findings stress the importance of specialized neurointensive care for these patients.