Prospective Study of Long-term Outcome After Non-aneurysmal Subarachnoid Hemorrhage

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Prospective Study of Long-term Outcome After Non-aneurysmal Subarachnoid Hemorrhage

Conditions
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Subarachnoid Hemorrhage

Intervention / Treatment
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* Other: SF-36


Participation Criteria
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Eligibility Criteria
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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.)
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| non-aneurysmal subarachnoid hemorrhage<br>patients with non-aneurysmal subarachnoid hemorrhage, short-term outcome measured by modified Rankin Scale and long-term outcome by SF-36 | Other: SF-36<br>* postal questionnaire consisting a short-form health survey with 36 simple questions (SF-36)<br>|
| perimesencephalic SAH<br>subgroup of non-aneurysmal subarachnoid hemorrhage | Other: SF-36<br>* postal questionnaire consisting a short-form health survey with 36 simple questions (SF-36)<br>|
| non-perimesencephalic (NPM) SAH<br>subgroup of non-aneurysmal subarachnoid hemorrhage | Other: SF-36<br>* postal questionnaire consisting a short-form health survey with 36 simple questions (SF-36)<br>|
| subgroup of NPM-SAH with Fisher 3<br>patients with non-aneurysmal (non-perimesencephalic) SAH and a Fisher 3 bleeding pattern | Other: SF-36<br>* postal questionnaire consisting a short-form health survey with 36 simple questions (SF-36)<br>|
| subgroup of NPM-SAH w/o Fisher 3<br>patients with non-aneurysmal (non-perimesencephalic) SAH and not a Fisher 3 bleeding pattern | Other: SF-36<br>* postal questionnaire consisting a short-form health survey with 36 simple questions (SF-36)<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Long-term outcome of all patients after non-aneurysmal SAH compared to standard population, measured by SF-36 | Long-term outcome of all patients after non-aneurysmal SAH compared to standard population, measured by SF-36 stratified to: non-aneurysmal SAH PM /NPM-SAH mRS 0 group NPM-SAH: Fisher 3 or non-Fisher 3 bleeding pattern | 18months to 15 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| mortality | deaths until long-term follow-up | 18months to 15 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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non-aneurysmal