Prospective Study of Long-term Outcome After Non-aneurysmal Subarachnoid Hemorrhage
Prospective Study of Long-term Outcome After Non-aneurysmal Subarachnoid Hemorrhage
Spontaneous subarachnoid hemorrhage (SAH) is usually caused by rupture of an intracranial
 aneurysm, but in up to 15% of patients with spontaneous SAH, no discernible bleeding source
 can be identified despite of repetitive radiological imaging. Patients, at least 18 months
 after ictus of a non-aneurysmal SAH, received a regular mail including a letter explaining
 the study purpose and the postal questionnaire consisting a short-form health survey with 36
 simple questions. If we didn't receive answers after three months we made telephone
 interviews with the patients' family members or their general practitioner.
Spontaneous subarachnoid hemorrhage (SAH) is usually caused by rupture of an intracranial
 aneurysm, but in up to 15% of patients with spontaneous SAH, no discernible bleeding source
 can be identified despite of repetitive radiological imaging. The blood distribution can be
 described as perimesencephalic/prepontine or non-perimesencephalic. Depending on the pattern
 of SAH the clinical course of the patients can be similar to aneurysmal SAH. In general,
 patients with a perimesencephalic SAH (PM-SAH) are considered to achieve good outcome and to
 have lower rebleeding risk. However, long-term outcome data on patients suffering from
 spontaneous non-aneurysmal SAH (non-aSAH) is scarce and lacking for physical and
 psychological outcome. Therefore, the aim of the present study was to investigate the
 long-term physical and psychological outcome in patients suffering from non-aneurysmal
 spontaneous SAH.

 SAH was confirmed on computed tomography (CT) or lumbar puncture. Only patients with a
 non-traumatic SAH were included. In our hospital algorithm all patients with SAH underwent
 angiography including 3D digital subtraction angiography (DSA) since 2002 to rule out
 intracranial sources for SAH. In case of a negative initial angiography, DSA was repeated
 after 14 days. Additionally, magnetic resonance imaging (MRI) of head/spine was performed to
 rule out any spinal bleeding sources. In patients with blood distribution exceeding the
 typical perimesencephalic pattern, a third DSA was performed 3 months after SAH. The first
 (short-term) follow-up (F/U) was performed six months after ictus. Outcome was measured
 according to the modified Rankin Scale (mRS) and stratified into favorable (mRS 0-2) and
 unfavorable (mRS 3-6) after six months. Patients with non-aSAH were divided into
 perimesencephalic SAH (PM-SAH), non-perimesencephalic SAH (NPM-SAH) and excellent Outcome
 group (mRS 0). Also the NPM-SAH group was further stratified into Fisher 3 blood pattern and
 NPM-SAH without Fisher 3 blood pattern.

 Patients, at least 18 months after ictus of a non-aneurysmal SAH, received a regular mail
 including a letter explaining the study purpose and the postal questionnaire consisting a
 short-form health survey with 36 simple questions. If we didn't receive answers after three
 months we made telephone interviews with the patients' family members or their general
 practitioner.
Inclusion Criteria:

 -  spontaneous, non-traumatic SAH

 -  SAH confirmed on computed tomography (CT) or lumbar puncture

 -  negative initial and follow-up angiography

 -  age: no limit

 Exclusion Criteria:

 -  traumatic SAH

 -  aneurysmal SAH

 -  SAH in whom other bleeding sources were identified (AVM etc.)