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  • Increased radiographic cerebral vasospasm and delayed clinical neurologic deficits in women after ruptured aneurysmal subarachnoid hemorrhage

    Final Number:

    Pui Man Rosalind Lai BA, MD; William B. Gormley MD; Nirav J. Patel MD, MA; Kai U. Frerichs MD; Mohammad Ali Aziz-Sultan MD; Rose Du MD, PhD

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: The prevalence of cerebral aneurysm is higher in women and emerging literature suggests women to experience worse morbidity and mortality after an aneurysmal rupture. The objective of this study was to evaluate the effects of gender on post-ictal radiographic vasospasm, delayed cerebral ischemia and clinical outcome.

    Methods: A total of 328 consecutive patients over 17 years with radiographic confirmed ruptured cerebral aneurysms were reviewed, comparing the demographics, presenting clinical and radiographic grades, radiographic vasospasm, delayed neurologic deficits, and follow up mRS outcome at 6 months to 1 year. Univariate and multivariate logistic analyses were used to compare men and women with statistical significance defined as p<0.05.

    Results: After multivariate adjustment, women had higher rates of radiographic vasospasm (r=0.33, 95%CI 0.048, 0.61) and clinical neurologic deficits (OR2.71, 95%CI 1.26, 5.82), but no difference was observed in radiographic ischemic infarct or clinical outcome. Younger age has a direct correlation with radiographic vasospasm in women (r=-0.028, 95%CI -0.037, -0.02) but not in men. Older age is associated with worse outcome in both groups, (r=0.043 95%CI 0.012, 0.074) in men, and (r=0.038 95%CI 0.02, 0.06) in women.

    Conclusions: Radiographic vasospasm and delayed neurologic deficits were found to be increased in women after an aneurysmal subarachnoid hemorrhage. This effect was not observed for ischemic infarct or follow up clinical outcome. This study further supports the unique role of sex and our need to better understand its involvement in the development of subarachnoid hemorrhage complications.

    Patient Care: There has been clinical suspicion that younger women develop worse cerebral vasospasm but no literature has yet established this relationship. We found increased radiographic vasospasm and delayed clinical ischemia in women, and an inverse relationship between cerebral vasospasm in women with age. Our study will bring awareness in the clinical setting and stimulate further study into the role of hormone in the development of subarachnoid hemorrhage complications.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the importance of understanding radiographic vasospasm and delayed clinical ischemia after aneurysmal subarachnoid hemorrhage. 2)Identify the role of gender as an association with radiographic vasospasm and delayed clinical ischemia


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