Introduction: Neurological condition at presentation is the most important predictor of morbidity and mortality from aneurysmal subarachnoid hemorrhage (aSAH). To guide management, it is important not only to identify aneurysms at high risk of rupture but also patients who are at risk of presenting in poor neurological condition after aSAH.
Methods: We retrospectively reviewed medical records and imaging studies for 387 consecutive cases of aSAH which were managed at a major academic neurovascular center in the United States from January 2008 to December 2013. Clinically accessible patient and aneurysm characteristics were evaluated by univariable analysis and multivariable logistic regression to identify predictors of poor neurological status at presentation.
Results: For all aneurysms, multivariable logistic regression identified age (OR=1.02, 95% CI=1.00–1.04, P=0.0129), aneurysm size (>=7 and <10 mm: OR=1.78, 95% CI=1.02–3.11, P=0.0429; >=10 mm: OR=3.22, 95% CI=1.82–5.70, P<0.0001), and vertebrobasilar junction location (OR=10.1, 95% CI=1.93–52.5, P=0.0060) as independent predictors of poor neurological condition at presentation. For ICA aneurysms, female gender (OR=9.21, 95% CI=1.54–55.1, P=0.0151), hypertension (OR=8.67, 95% CI=1.80–41.7, P=0.007), and size >=7 mm (OR=3.67, 95% CI=0.852–15.8, P=0.0807) were predictive of poor neurological condition at presentation, with a C statistic of 0.842. No association was found between poor neurological grade at presentation and smoking status or warfarin therapy.
Conclusions: Independent predictors of poor neurological grade were identified for all, ICA, ACA/ACOMM, MCA, and posterior circulation aneurysms. A risk prediction chart was constructed using clinically accessible patient and aneurysm characteristics for poor presenting neurological condition after ICA aneurysm rupture. These factors should be considered when counseling patients with unruptured intracranial aneurysms.
Patient Care: 1) By identifying patients with unruptured intracranial aneurysms who are at high risk of poor outcome from aSAH and who may benefit from prophylactic treatment
2) By improving patient and provider knowledge of the risks and benefits of available options for management of unruptured intracranial aneurysms
3) By allowing for more accurate counseling of patients with unruptured intracranial aneurysms
Learning Objectives: By the conclusion of this session, participants should be able to 1) identify risk factors for poor neurological condition at presentation after aSAH and 2) discuss implications for counseling patients with unruptured intracranial aneurysms.