gms | German Medical Science

Objective: Refractory vasospasms remain a hazardous complication in the course of (aneurysmal) subarachnoid hemorrhage (SAH). The aim of this study was to identify risk factors for refractory vasospasms in a single center patient cohort.

Methods: Between 2003 and 2015 a total of 955 consecutive patients with SAH were treated. Vasospasms were detected by transcranial Doppler sonography on the ICU according to predefined criteria and confirmed by digital subtraction angiography (DSA). Vasospamolysis was done interventionally with nimodipine and / or ballon angioplasty wherever necessary. Patients records were analyzed and the data of patients with only one vasospasm and of patients who suffered from two or more vasospasms, defined as refractory vasospasms, were compared by |²-test in regard tosex, Hunt & Hess grade at admission and concomitant meningitis.

Results: A total of 164 patients (17.2%) with vasospasms was identified by DSA, 119 female (72.6%) and 45 male patients (27.4%) were in this series. In 80 patients two or more vasospasmolyses were performed. There was no significant association between the number of vasospasms and Hunt & Hess grade at admission (p=0.157), sex (p=0.867) or accompanying meningitis (p=0.336). Nevertheless, amongst patients requiring multiple vasospasmolyses (defined as 5+; n=12) were 10 female and 2 male patients.

Conclusion: Despite a very large series of patients suffering from SAH, statistical analysis failed to identifiy factors that might be associated with refractory vasospasms. The common prejudice that women are more prone to experience vasospasms after SAH in general cannot hold stand according to our data. More research has to be done to identify who is at risk for severe refractory vasospasms.