Incidence of Aneurysmal Subarachnoid Hemorrhage and Analysis of Factors Involved in Early Aneurysm Rebleeding:

Incidence of Rebleed Following Cerebrospinal Fluid (CSF) Drainage in Poor Grade Subarachnoid Hemorrhage: An Institutional Experience

BACKGROUND

The outcome of poor grade subarachnoid hemorrhage (SAH) is dismal. Some of these patients need cerebrospinal fluid (CSF) drainage procedure for the hydrocephalus and intraventricular hemorrhage (IVH) which may precipitate rebleeding. However, aneurysmal rebleed following CSF drainage procedure is controversial.

OBJECTIVE

Our study aimed at analyzing the effect of CSF drainage procedure on aneurysmal rebleeding.

MATERIAL AND METHODS

We retrospectively analyzed the records of all the consecutive patients diagnosed with poor grade aneurysmal SAH over three year period. Patients initially requiring either external ventricular drainage (EVD) or lumbar drain (LD) were included in the study group, and the rest (not requiring drainage) were included in the control group. Rebleeding was confirmed on computed tomography. The factors affecting rebleeding were analyzed.

RESULTS

Overall 194 patients with poor grade SAH were enrolled in the study (91 males: 103 females; mean age: 50.6 years). The study group had 91 patients (83 EVD and 8 LD) while 103 patients were in the control group. Posterior circulation aneurysms, poor grade SAH, hydrocephalus, and IVH were more common in the study group P < 0.001. The rebleeding rate was 7.6% in the study group and 8.7% in the control group. On univariate analysis size >1 cm, multiplicity, multilobularity, vasospasm, and CSF drainage were significant risk factors for rebleeding (P < 0.001). On multivariate analysis aneurysm size >1 cm, CSF overdrainage >250 ml/day were significantly associated with risk of rebleeding.

CONCLUSION

Ventricular drainage is essential to relieve acute hydrocephalus and drain IVH in SAH and we found no significant association between CSF drainage and rebleeding. However, rapid overdrainage of CSF can lead to aneurysm rupture, hence controlled controlled CSF drainage should be undertaken.

The relationship between rebleeding after spontaneous SAH and APOE polymorphisms in a Chinese population

Rebleeding leads to lots of patients' disability and mortality after spontaneous subarachnoid hemorrhage (SAH), but the risk factors of rebleeding have not been fully understood. More evidence showed apolipoprotein E (apoE protein, APOE gene) influenced the outcome of spontaneous SAH. In this study, we aimed to investigate the relationship of APOE polymorphisms with rebleeding after spontaneous SAH. A total of 185 patients with spontaneous SAH were involved in the current study. Genomic DNA was extracted from venous blood samples to identify the APOE genotype by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Rebleeding was defined as acute clinical deterioration that was accompanied by computed tomography (CT) evidence of rebleeding in the subarachnoid space. A total of 21 patients occurred rebleeding in 185 patients with spontaneous SAH in the hospital. Data were analyzed by χ(2)-test and logistic regression analyses. The statistical analysis indicated no significant association between APOE genotype and rebleeding in a Chinese population.