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Non-aneurysmal subarachnoid hemorrhage

Abstract:

Objective: Determine the clinical characteristics of nonaneurysmal subarachnoid hemorrhage (ASH-A).Methods: a descriptive study was conducted of a prospective series of 204 patients with spontaneous subarachnoid hemorrhage consecutively admitted to the Stroke Unit at Hermanos Ameijeiras Hospital in Havana from October 2005 to December 2009.Results: 165 patients had cerebral aneurysms, of which 157 were identified by angiography (155 in the first study and 2 in the second), and 8 by necropsy. In 39 cases the cause was non-aneurysmatic. The following causes were identified in 8 patients: moyamoya disease (2 cases), cerebral venous angioma (2 cases), spinal arteriovenous malformation (AVM), dural AVM, artery dissection of the vertebrobasilar system and pituitary apoplexy. 31 patients (15.2%) had cryptogenic hemorrhage, and four presented anomalous venous drainage. NA-SAH was associated with a lower frequency of hypertension (p= 0.029) and smoking (p= 0.025). Angiographic vasospasm was observed in 55 cases with aneurysms (33.3%) and in one case with NA-SAH (2.6%) (p< 0.001). Symptomatic vasospasm was observed in 25 cases with aneurysms (15.2%) and in none with NA-SAH (p= 0.063). There was rebleeding in 31 cases with A-SAH (18.8%) and in only one case with NA-SAH (2.6%) (p= 0.024). The final outcome at discharge measured with the modified Rankin scale was better for NA-SAH (p= 0.002). There were 25 deaths with aneurysms (15.2%) and none with NA-SAH (p= 0.02).Conclusions: NA-SAH has a good prognosis. In most cases neurovascular research is unable to identify its cause.