The value of modified hijdra score in patients with aneurysmal subarachnoid hemorrhage

Background

The complexity of calculating the Hijdra score has limited its clinical utility in aiding the diagnosis of intracranial ruptured aneurysms.

Objective

This study aimed to investigate the diagnostic and prognostic value of the modified Hijdra score in patients with aneurysmal subarachnoid hemorrhage (aSAH).

Methods

Data from 773 patients with subarachnoid hemorrhage (SAH) at the First People's Hospital of Lianyungang from January 2018 to June 2023 were collected. The modified Hijdra scoring method simplifies the assessment of 10 basal cisterns/cisterns fissures compared to the traditional scoring method, with scores ranging from 0 to 2 for each item, and assigns specific scores to hematomas larger than 1 cm in diameter. The data were divided into an evaluation group (n = 641) and a validation group (n = 132). In the evaluation group, the performance of the modified Hijdra score in diagnosis and prognostic prediction was assessed, while the diagnostic and prognostic prediction efficacy of the modified Hijdra method was evaluated using the validation set.

Results

Among the 641 patients in the evaluation group,550 (85. 8%) were diagnosed with intracranial aneurysms. The modified Hijdra score demonstrated an AUC of 0. 894 for aneurysm diagnosis, with a sensitivity of 98. 0% and a specificity of 64. 8% at a CutOff value of 7. 5. The diagnostic efficacy of the modified Hijdra score was 93. 24%, with a negative predictive value of 84. 29%, while the Hijdra score 's diagnostic efficacy was 85. 34% with a negative predictive value of 48. 89%. The AUC of the modified Hijdra score for predicting prognosis in patients with aneurysms was 0. 824, with a sensitivity of 84. 3% and a specificity of 70. 0% at a CutOff value of 16. 5. In CTA-negative patients, the modified Hijdra score was significantly higher (P < 0. 0001) in patients with aneurysmal SAH (15. 48 ± 3. 93) compared to those with non-aneurysmal SAH (6. 31 ± 4. 52).

Conclusions

The modified Hijdra score is a valuable tool for assisting in the diagnosis and prognosis prediction of aneurysmal subarachnoid hemorrhage.

The diagnostic yield of repeat computed tomography angiography in cases of spontaneous subarachnoid haemorrhage after negative initial digital subtraction angiography

Purpose

It is currently unclear how useful repeat computed tomography angiography (CTA) is in spontaneous subarachnoid haemorrhage (SAH) patients after negative initial digital subtraction angiography (DSA). The purpose of this study is to assess the yield of repeat CTA for the detection of causative vascular lesions in patients with SAH in whom there has been a negative initial DSA.

Material and methods

This observational retrospective study was carried out from January 2013 to July 2022 at a single institution. Analysis of the SAH pattern on unenhanced CT showed that patients were divided into perimesencephalic SAH and diffuse SAH groups. A repeat CTA was performed on all spontaneous SAH patients who had a nega-tive initial CTA and DSA within a 2-week period. An interventional neuroradiologist and a diagnostic radiologist examined all images to search for causative vascular abnormalities.

Results

Forty-seven patients were included in our study, with a median age of 55 years and a range of 28-81 years. Thirty-seven had diffuse SAH (66%), and 16 had perimesencephalic SAH (34%). The repeat CTA revealed 2 causa-tive vascular lesions (a right PICA aneurysm and a mycotic aneurysm) in 2 separate patients (yield of 4.3%), both of whom had diffuse SAH (yield of 6.5%). In retrospect, none of these vascular lesions were evident in the initial CTA and DSA. No evidence of re-bleeding was observed in the follow-up period.

Conclusions

It is beneficial to repeat CTA when evaluating patients with diffuse SAH who initially present with nega-tive initial DSA. For occult aneurysms, the diagnostic yield of the follow-up CTA is 6.5%.

Delayed appearance of basilar trunk small atypical aneurysms in nontraumatic, initially angiogram-negative subarachnoid hemorrhage: A report of three patients

BACKGROUND

Repeat angiography will identify vascular pathology in approximately 10% of cases following angiogram-negative subarachnoid hemorrhage (anSAH), but small atypical aneurysms of the basilar artery are very uncommon.

OBJECTIVE

To report a case series of delayed appearance of nontraumatic basilar artery small atypical aneurysms.

METHODS

IRB approval was obtained for this retrospective case series and patient consent was waived.

RESULTS

Herein we report three cases of spontaneous anSAH, all of whom had a negative digital subtraction angiogram (DSA) on admission and all of whom had appearance of a small atypical aneurysms of the upper basilar trunk/apex on follow-up imaging (two during the initial admission and one in a delayed fashion). All three patients were ultimately treated with flow diversion (although one patient underwent attempted coiling that was abandoned due to inability to catheterize the aneurysm).

CONCLUSION

This report highlights the importance of a repeat DSA in cases of anSAH as well as the importance of scrutinizing the basilar trunk for these very small atypical aneurysms that may go unnoticed.

Clinical Outcome and Prognostic Factors of Patients with Perimesencephalic and Nonperimesencephalic Subarachnoid Hemorrhage

OBJECTIVE

To demonstrate the clinical outcome of patients with nonperimesencephalic subarachnoid hemorrhage (npSAH) compared with patients with aneurysmal SAH (aSAH) and perimesencephalic SAH (pSAH) and to evaluate predictive value of various clinical and radiological findings in patients with npSAH.

METHODS

We retrospectively identified patients with SAH who presented at our institution between 2009 and 2018. We analyzed demographic and clinical data and outcomes. Multivariable analysis was performed for outcome parameters.

RESULTS

Of 608 patients with confirmed SAH, 78% had aSAH, and 22% had nonaneurysmal SAH. Nonaneurysmal SAH was perimesencephalic in 30% of cases and nonperimesencephalic in 70%. Initial clinical status (Hunt and Hess score) was significantly worse in patients with aSAH compared with patients with nonaneurysmal SAH. Complications such as delayed cerebral ischemia occurred significantly more often in patients with aSAH. Patients with pSAH had a more favorable clinical course than patients with aSAH or npSAH. There was no significant difference in 30-day mortality between aSAH (29%) and npSAH (28%) patients (P = 0.835). Hunt and Hess score emerged as a strong predictor of unfavorable outcome in both aSAH and npSAH in multivariable regression.

CONCLUSIONS

Patients with npSAH had a similar clinical outcome as patients with aSAH, although there were significantly fewer clinical complications in patients with npSAH. Patients with pSAH demonstrated an overall good clinical course. Our multivariable analysis showed that initial Hunt and Hess score was an important predictor for clinical outcome in aSAH as well as npSAH.

The Potential Value of 320-Row Computed Tomography Angiography in Digital Subtraction Angiography-Negative Spontaneous Subarachnoid Hemorrhage Patients

Objective

This study aimed to investigate the clinical value of multiphase and multiparametric 320-row computed tomography (CT) in the long-term follow-up of spontaneous subarachnoid hemorrhage (SAH) with initially negative CT angiography (CTA) and digital subtraction angiography (DSA) results.

Methods

We retrospectively analyzed the clinical data of 35 patients with nontraumatic angiographically negative SAH results from February 2012 to December 2015. Regular follow-up was performed with 320-row CTA, CT venography, and CT perfusion.

Results

All patients received 320-row CT follow-up for 0.5 to 4 years. The diagnostic yield of the follow-up examinations was 4 of 35 (11.4%), 3 of 31 (9.7%), and 1 of 28 (3.6%) for the first, second, and third time points, respectively. Two patients were admitted to the hospital because of recurrent subarachnoid hemorrhage during the follow-up period and diagnosed with ruptured aneurysms.

Conclusions

Patients with SAH with negative findings in the first DSA examination require to follow up. Follow-up using 320-row CTA, CT venography, and CT perfusion allows for a noninvasive diagnostic test for cerebrovascular diseases with higher compliance and fewer complications when compared with follow-up using DSA.

Factors determining outcome of post-angiogram-negative subarachnoid hemorrhage

Aim:

To determine the risk factors affecting outcome at the end of 90 days of post-angiogram-negative subarachnoid hemorrhage (SAH).

Methods:

Non-traumatic SAH cases were reviewed from the case records of patients who had reported to the Department of Neurology of a tertiary care hospital and 50 angio-negative SAH cases were included after excluding all the cases with known cause of hemorrhage after doing computed tomography angiography (CTA)/digital subtraction angiography (DSA). The presence of hypertension, diabetes mellitus, coronary artery disease (CAD), history of alcohol and smoking, and various scales like Hunt and Hess Scale (HHS), World Federation of Neurological Surgeons (WFNS), and Fisher scale had been recorded at admission. The outcome was assessed at 90 days post-SAH using the Modified Rankin Scale (mRS).

Statistical analyses:

The association between the outcome and the factors was assessed using the Pearson Chi-Square test and the risk factors/predictors of outcome were assessed using logistic regression.

Results:

The following variables were important risk factors for predicting poor outcome of angio-negative SAH (mRS 3 to 6): hypertension (P = 0.011), diabetes mellitus (P = 0.032), being an alcoholic (P = 0.019), HHS grade 4 to 5 (P < 0.01), and WFNS grade 4 to 5 (P < 0.01). On multivariate regression analysis, hypertension (P = 0.032) was an independent predictor of unfavorable outcome.

Conclusions:

At time of admission, presence of hypertension, diabetes mellitus, history of alcohol consumption, and poor grades of HHS and WFNS scale are predictors of poor outcome of angio-negative SAH.