Journal of Korean Society of Geriatric Neurosurgery 2016;12(2):118-124.
Published online September 30, 2016.
Predictive Factors for Intracerebral Hematoma Volume and Increased Short-Term Mortality in Elderly Patients with Subarachnoid Hemorrhage due to Rupture of Middle Cerebral Artery Aneurysm
Byeong-Jin Ha1 , Hyeong-Joong Yi1 , Yong Ko1 , Jin-Hwan Cheong2 , Kyu-Sun Choi1 , Myung-Hoon Han2
1Department of Neurosurgery, Hanyang Seoul Hospital, Hanyang University College of Medicine, Seoul, 2Department of Neurosurgery, Guri Hospital, Hanyang University College of Medicine, Gyonggi-do, Korea
Patients suffering from subarachnoid hemorrhage (SAH) and additional intracerebral hematoma (ICH) usually have a poor outcome. One of the most common locations of ruptured aneurysm in those patients with ICH is a middle cerebral artery (MCA). The aim of this study is to determine the predictive factors for ICH volume and investigate the relationship between clinical factors with mortality of patients with ruptured MCA with concurrent ICH.
We retrospectively analyzed the data of 61 patients with SAH and additional ICH due to ruptured MCA aneurysm from our hospital records between 2007 and 2015. Univariable and multivariable linear regression analysis were performed to assess the associations of various factors with initial ICH volume. To evaluate the potential independent prognostic factors on mortality, the 90-day survival rate was analyzed.
According to the multivariate linear regression analysis, hypertension, diabetes and aneurysm diameter (β=1.59; standard error (SE) 0.77; p=0.044) were associated with ICH volume in the ruptured MCA patients. Age ≥65 (hazard ratio (HR) 1.07; 95% CI 1.02-1.12; p=0.003), aneurysm diameter >7mm(HR 1.15; 95% CI 1.04-1.26; p=0.007) and use of antiplatelet agent showed significant association with 90-day mortality.
There was significant association between aneurysm diameter, hypertension and diabetes with ICH volume in the patients with ruptured MCA aneurysm. Aneurysm diameter was the only significant risk factor for mortality among the predictors of increasing ICH volume in patients with ruptured MCA aneurysm.
Key Words: subarachnoid hemorrhage; intracerebral hematoma; middle cerebral artery; aneurysm diameter; mortality
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