gms | German Medical Science

Objective: Sodium disturbances are frequently observed in the acute stage of aneurysmal subarachnoid haemorrhage (SAH). Particularly hyponatremia (HON) contributes to symptomatic vasospasm (SV), which is often related to poor outcome. This prospective study aims to evaluate the incidence and characteristics of sodium and water disturbances after SAH in the acute stage and to analyze their impact on SV and outcome before discharge and at 6-months follow-up (6-FU).

Methods: Since 2007 70 patients were enrolled into the study. At four different visits (V1–4) V1= day of admission and aneurysm rupture, V2= day 3, V3= day 7, V4= day 14–21 (before discharge), daily natriuresis, blood sodium level, water balance, osmolality in blood and urine were measured. Measurements were available for 59 patients at V1 and V2, respectively, for 54 at V3 and for 53 at V4. Clinical status was classified by Hunt & Hess scale (HH); CT scans were evaluated by the Fisher scale. SV was defined as increased flow velocity (>120cm/sec.) measured by daily Doppler ultrasound accompanied by neurological deterioration. Outcome was assed by the Glasgow outcome scale (GOS).

Results: There were 32 patients HH 2, 16 patients HH 4, 10 patients HH 3, 9 patients HH 5 and 3 patients HH 1. CT scans were classified as Fisher grade 4 in 28, 3 in 16, 2 in 18 and 1 in 8 cases. HON occurred on 57% of our patients and was measured in n=14 at V1, n=4 at V2, n=10 at V3 and n=12 at V4. A negative water balance was noticed in n=18 at V1, n=34 at V2, n=19 at V3 and n=11 at V4. SV was diagnosed in 19 patients. At V4 28 patients presented in GOS 4, 27 in GOS 3, 6 in GOS 2 and 9 patients had died (GOS 1). 33/61 patients have already been examined at 6-FU: GOS 5 n=7, GOS 4 n=17, GOS 3 n=3, GOS 2 n=3. 3 patients had died between V4 and 6-FU (GOS 1 n=3). HON and/or water disturbances at V1-V4 showed no significant influence on SV occurrence or GOS. Multivariate analysis including HH, Clip, Coil, Aneurysm-location (AL), Fisher grade revealed only AL at the anterior communicating artery (Acom) and middle cerebral artery (MCA) as independent factors significantly contributing to HON at V1 (p=0,036).

Conclusions: HON was recorded in more than half of our patients. Bleeding from Acom and MCA aneurysms were significantly related with HON at admission. But contrariwise to the literature HON neither had influence on SV occurrence nor on GOS in this cohort.