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Patient age and vasospasm after subarachnoid hemorrhage
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
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2010 (English)In: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 67, no 4, 911-917 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Subarachnoid hemorrhage (SAH) from a ruptured intracranial aneurysm is a devastating disease with high mortality and morbidity. The incidence of SAH increases with advancing age. OBJECTIVE: To determine whether age is an independent predictor of angiographic vasospasm, delayed ischemic neurological deficits (DINDs), or abnormal transcranial Doppler (TCD) measurements in patients with aneurysmal subarachnoid hemorrhage. METHODS: Data from CONSCIOUS-1 (Clazosentan to Overcome Neurological Ischemia and Infarct Occurring After Subarachnoid Hemorrhage study), a dose-finding study of clazosentan, were used. Data on angiographic vasospasm, DINDs, and TCD abnormalities were prospectively recorded as well as baseline characteristics and treatment data. Patient age was considered in 3 ways: as a continuous variable, dichotomized at age 65 years, and categorized by decade. Age was investigated as the main variable, whereas other possible confounding variables were adjusted for in the multiple logistic regression modeling with each of 3 dichotomized vasospasm outcome measures, presence or absence of angiographic vasospasm, DINDs, and TCD abnormalities as the dependent variable. RESULTS: The proportions of patients with angiographic vasospasm, DINDs, and TCD abnormalities were 45%, 19%, and 81%, respectively. Age, whether considered as a continuous, dichotomous, or a categorical variable, was not significantly associated with angiographic vasospasm, DINDs, or abnormal TCD measurements. CONCLUSION: Age does not seem to be a significant predictor for cerebral vasospasm after subarachnoid hemorrhage.

Place, publisher, year, edition, pages
2010. Vol. 67, no 4, 911-917 p.
Keyword [en]
Aneurysm, Cerebral vasospasm, Delayed ischemic neurological deficits, Elderly, Subarachnoid hemorrhage, Transcranial Doppler
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-97926DOI: 10.1227/NEU.0b013e3181ed11abISI: 000282197900023OAI: oai:DiVA.org:uu-97926DiVA: diva2:173046
Available from: 2008-12-19 Created: 2008-12-19 Last updated: 2017-12-14Bibliographically approved
In thesis
1. Subarachnoid Hemorrhage in the Elderly
Open this publication in new window or tab >>Subarachnoid Hemorrhage in the Elderly
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Subarachnoid hemorrhage (SAH) is a disease with high risk of mortality and morbidity. Elderly patients have an even higher risk of poor outcome. The incidence of SAH increases with age and the elderly constitute a substantial and increasing proportion of the population. Thus, the management of elderly SAH patients is an imminent clinical challenge. Time trends in clinical management and outcome were investigated in 281 SAH patients aged ≥65 years admitted over an 18-year period. The volume of elderly patients, especially patients ≥70 years and patients in worse clinical condition increased over time. The proportion of patients with favorable outcome increased over time, without an increase in severely disabled patients. Technical results and clinical outcome of endovascular aneurysm treatment (EVT) was investigated in 62 elderly SAH patients. EVT can be performed in elderly SAH patients with high technical success, acceptable aneurysm occlusion degree, acceptable procedural complication rate, and fair outcome results. EVT was compared to neurosurgical clipping (NST) in 278 elderly SAH patients in the International Subarachnoid Aneurysm Trial. In good grade elderly SAH patients, EVT should probably be the favored treatment for internal carotid and posterior communicating artery aneurysms, while elderly patients with middle cerebral artery aneurysms appear to benefit from NST. Occurrence of secondary insults and their impact on clinical deterioration were studied in 99 patients with severe SAH. High intracranial pressure increased and high cerebral perfusion pressure decreased the risk of clinical deterioration. Elderly patients had less intracranial hypertension insults and more hypertensive, hypotensive and hypoxemic insults. Good outcome was achieved in 24% of elderly patients with severe SAH, and the proportion of severe disability was similar to that of younger patients. Patient age was not a significant predictor for vasospasm in 413 SAH patients when admission and treatment variables were adjusted for with multiple logistic regression.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 106 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 407
Keyword
subarachnoid hemorrhage, intracranial aneurysm, elderly, outcome, endovascular coiling, neurosurgical clipping, secondary insult, cerebral vasospasm
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-9504 (URN)978-91-554-7375-4 (ISBN)
Public defence
2009-01-09, Enghoffsalen, Akademiska sjukhuset, ing 50, Uppsala, 09:15
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Available from: 2008-12-19 Created: 2008-12-19 Last updated: 2011-01-12Bibliographically approved

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