Spontaneous Subarachnoid Hemorrhage Caused By Aneurysm: The Retrospective Analysis of 328 Cases

Year 2012, Volume: 17 Issue: 3, 156 - 160, 01.06.2012

Yılmaz İlhan Metehan Eseoğlu Bülent Timur Demirgil

Abstract

Objective: In this study the factors that affect the prognosis in aneurysm based spontaneous surbarachnoid hemorrhage are reviewed accompanied by the literature. Materials and Methods: 328 SAH cases who were referred to our hospital between January 1995-2005, were analyzed retrospectively in terms of aetiological, clinical and radiological findings. Female/Male rate was found as 1,2. Ages of the patients were changing from 4 to 93. Neurological evaluations of the patients were made according to the Glasgow Coma Scale and Yasargil criteria; and CT findings were evaluated according to the Fisher classification. Besides we analyzed the relation between age, gender and season. The results were discussed by taking the literature into account. Results: The most frequent reason of spontaneous surbarachnoid hemorrhage caused by aneurysm is the anterior communicane artery aneurysm. The average age was determined as 48.6. The most common complaint of the patients when they were referred to our clinic was headache (70.1%). SAH diagnosis was done via cranial CT for 305(93%) cases of all 328 cases. The frequency of observation of SAH seemed to be on increase especially in autumn. According to the Yasargil classification; the most common phase that observed in the cases was ‘ Phase 2a' , and according to Fisher classification the most common phase was ‘Phase 2'. Conclusion: CT is the most common method to diagnose SAH in the first 72 hours. Magnetic Resonance or Lomber Puncture should be applied when diagnose is not possible with CT. Digital substraction angiography is the first.

Keywords

-

Anevrizmaya Bağlı Spontan Subaraknoid Kanamalar: 328 Vakalık Retrospektif İnceleme

Abstract

Amaç: Bu çalışmada anevrizma kökenli spontan subaraknoid kanamalarda prognozu etkileyen faktörler literatür eşliğinde gözden geçirildi. Gereç ve Yöntem: Bu çalışmada Ocak 1995-2005 yılları arasında kliniğimize başvuran 328 SAK olgusu retrospektif olarak, etyolojik klinik ve radyolojik bulgulara göre incelendi. K/E oranı 1,2 olarak bulundu. Yaş dağılımı 4 ile 93 yaş arasındaydı. Hastaların nörolojik değerlendirilmesi Glaskov Koma Skalası ve Yaşargil kriterlerine göre, Bilgisayarlı Tomografi bulguları (BT) ise; Fisher sınıflandırılmasına göre değerlendirildi. Ayrıca çalışmamızda Sak'ın yaş, cinsiyet ve mevsimsel ilişkisi incelendi. Sonuçlar literatürde karşılaştırılarak tartışıldı. Bulgular: Anevrizmaya bağlı spontan subaraknoid kanamaların ensık sebebi (%32,8) anterior komminikan arter anevrizmasıdır. Ortalama yaş 48,6 olarak bulundu. Başvuru anındaki ensık şikayetin başağrısı (%70,1) olduğu görüldü. 328 olgunun 305'inde (% 93) subaraknoid kanamaların tanısı kranial BT ile kondu, subaraknoid kanamaların görülme sıklığının özellikle sonbaharda arttığı tespit edildi. Yaşargil sınıflmasına göre vakalarda ensık Evre 2a, Fisher sınıflamasına göre ensık Evre 2 tespit edildi. Sonuç: SAK ta ilk 72 saatte tanı koymada BT en yaygın yöntemidir. BT ile tanı konulamayan durumlarda Magnetik Rezonans veya Lomber Ponksiyon yapılmalıdır. Dijital substraksiyon anjiyografi anevrizma tespitinde ilk tercihtir.

Keywords

Subaraknoid kanama, Anevrizma, Klinik sonuçlar

References

• Lazino G, Kassel NF, Germanson TP. Age and outcome after aneurysmal subarachnoid hemorrhage: why the older patients fare worse. J Neurosurg 1996; 85: 410-8.
• Longstreth WT, Nelson LM, Koepsell TD. Clinical course of subarachnoid hemorrhage: A population-based study in king county, Washington. Neurology 1993; 43: 712-8.
• Bozkuş H. Subarachnoid hemorrhage in the elderly. J Neuro- surg 1993; 7: 307-9.
• Kassell NF, Torner JC, Haley EC Jr, Jane JA, Adams HP, Kongable GL and participants. The international cooperative study on the timing of aneurysm surgery. Part I: Overall ma- nagement results. J Neurosurg 1990; 73: 37-47.
• Inagawa T, Yamamoto M, Kamiya K, Ogasawara H. Manage- ment of elderly patients with aneurmal subarachnoid hemorr- hage. J Neurosurg 1988; 69: 332-9.
• Chayette D, Chen TL, Bronstein K. Seasonal fluctuation in the incidence of intracranial aneurysm rupture and its relationship to chancing climatic conditions. J Neurosurg 1994; 81: 525- 30.
• Kopitnik TA, Samson DS. Management of subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 1993; 56: 947-59.
• Leablanc R. The minor leek preceding subarachnoid hemorr- hage. J Neurosurg 1987; 66: 35-9.
• Weir B. Aneurysms affecting the nervous system. Baltimore Williams and Wilkins, 1994.
• Fazekas F, Kleinert R, Roob G, et al. Histopathologic analysis of foci of signal loss on gradient-echo T2-weighted MR ima- ges in patients with spontaneous intracerebral hemorrhage: Evidence of microangiopathy-related microbleeds. AJNR Am J Neuroradioloji 1999; 20: 637-42.
• Noguchi K, Ogawa T, Seto H, et al. Subacute and chronic subarachnoid hemorrhage: Diagnosis with Fluid-Attenuated Inversion Recovery MR imaging. Radiology 1997; 203: 257- 62.
• Tatter SB, Crowell RM, Ogilvy CS. Aneurysmal and microa- neurysmal “angionegative” subarachnoid hemorrhage. Neuro- surgery 1995; 37: 48-55.
• Jayaraman MV, Mayo-Smith WW, Tung GA, et al. Detection of aneurysms; multidetector row CT angiography compared with DSA. Radiology 2004; 230: 510-8.
• White PM, Teasdale EM, Wardlaw JM, Easton V. Intracranial aneurysms: CT angiography and MR angiography for detec- tion prospective blinded comparison in a large patient cohort. Radiology 2001; 219: 739-49.
• Beguelin C, Seiler R. Subarachnoid hemorrhage with normal cerebral pananjiography. Neurosurgery 1983; 13: 409-11.
• Brismar J, Sundbarg G. Subarachnoid hemorrhage of unknown origin prognosis and prognostic factors. J Neurosurg 1985; 63: 349-54.
• Van Gijn J, Rinkel GJE. Subarachnoid haemorrhage: Diagno- sis, causes, and management. Brain 2001; 124: 249-78.
• Herrmann LL, Zabramski JM. Nonaneurysmal subarachnoid hemorrhage: A review of clinical course and outcome in two hemorrhage patterns. J Neurosci Nurs 2007; 39: 135-42.
• Erdoğan A. Anterior kommünikan arter anevrizmaları. Temel Nöroşirürji Ankara 1997: 1-13.
• Mayberg M.R. Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage A Statement for Healthcare Pro- fessionals From a Special Writing Group of the Stroke Council, American Heart Association, 1994.
• Canbolat A, Bozbuğa M, Hamamcıoğlu MK. Erken anevrizma cerrahisi. Tıp Fak Mecmuası 1994; 57: 23-31.
• Sundt TM. Cerebral vasospasm following subarachnoid he- morrhage: evolution, management, and relationship to timing of surgery. Clin Neurosurg 1977; 24: 228-39.
• Gönderilme Tarihi: 11.01.2012