Intraventricular extension of an aneurysmal subarachnoid hemorrhage is an independent predictor of a worse functional outcome

Mario Zanaty, Daichi Nakagawa, Robert M. Starke, Enrique C. Leira, Edgar A. Samaniego, Waldo G. Guerrero, James Torner, Yasunori Nagahama, Olatilewa Awe, Jeremy Greenlee, Joseph S. Hudson, Lauren Allan, Reem Elwy, Nohra Chalouhi, Pascal Jabbour, Royce Woodroffe, Anthony Piscopo, David Hasan

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objective: The objective of this study is to determine the impact of intraventricular hemorrhage (IVH) on the cognitive prognosis of subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm, independent of the presence of intraparenchymal hemorrhage, hydrocephalus or vasospasm. Patient and Methods: A Retrospective review of a prospectively collected database of patients with aneurysmal SAH from July 2009 to November 2016 was performed. Patients were included if they had a saccular aneurysm with a Hunt-Hess grade (HHG) 1–3. Those who underwent craniectomy/clipping and those with vasospasm were excluded. Patients with IVH were grouped into 5 groups depending on the blood distribution in the ventricles. Functional outcomes studied were modified Rankin score (mRS) 0–2, cognitive impairment and memory impairment, and the presence of amnesia to the event. A univariate followed by a multivariate analysis ware performed. Results: A total of 443 patients were identified and 124 patients met the criterion. There were no significant differences in the proportion of patients with mRS of 0–2 between patients with IVH and those without IVH but with EVD (external ventricular drain). There was a higher proportion of cognitive deficits in patients with IVH (71.95%), compared to those without (31.58%; p = 0.01). Patients with IVH had a higher rate of anterograde amnesia (100% vs. 4.3% p < 0.0001), lower rate of mRS 0–2 (78% vs 100% p < 0.001), and higher rate of cognitive impairment (71.9% vs. 13% p < 0.0001) compared with those who did not require an EVD. Grade 3 and grade 4 were shown to have lower rate of patients with mRS 0–2 and a higher rate of cognitive impairment. In multivariate analysis, independent predictors of cognitive and memory impairment were increasing HHG (OR = 155.33; P < 0.01), ACOM/A1/ACA/anterior choroidal aneurysms, (OR = 5.24; P = 0.04), increasing Fischer scale (OR = 6.93; P = 0.01), and increasing IVH grade (OR = 6.9; P = 0.01). Only worse HHG (OR = 2704.22; P = 0.01) and IVH grade 2–4 were associated (perfect predictor, OR cannot be extracted) with anterograde amnesia. Conclusion: IVH is an independent prognosticator of SAH cognitive outcomes. The effect of IVH drainage and other intraventricular therapies on SAH course is an attractive topic for further investigation.

Original languageEnglish (US)
Pages (from-to)67-72
Number of pages6
JournalClinical Neurology and Neurosurgery
Volume170
DOIs
StatePublished - Jul 2018

Keywords

  • Cognition
  • Functional outcome
  • IVH
  • Memory deficit
  • SAH

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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