Association of a younger age with an increased risk of angiographic and symptomatic vasospasms following subarachnoid hemorrhage

Clinical article

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  • 1 Department of Neurosurgery and
  • | 2 Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania;
  • | 3 Colorado Neurological Institute, Englewood, Colorado; and
  • | 4 Department of Neurosurgery, Mount Sinai Hospital, New York, New York
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Object

Vasospasm is a leading cause of morbidity and death following aneurysmal subarachnoid hemorrhage (SAH). It is important to predict which patients are at risk for vasospasm so that interventions can be made. There are several potential risk factors for vasospasm, one of which is age. However, the effect of age on vasospasm, particularly symptomatic vasospasm, remains controversial.

Methods

Three hundred ninety-one patients were retrospectively identified from a prospective observational database of patients with SAH who had been admitted to a single center. Demographic and clinical data were recorded, and cerebral angiograms obtained at admission and between 5 and 10 days later were compared. The relationship between age and angiographic and symptomatic vasospasms was examined using logistic regression techniques.

Results

Mild (86 patients), moderate (69 patients), severe (56 patients), and no angiographic vasospasms (180 patients) were documented by comparing admission and follow-up angiograms in each patient. Symptomatic vasospasm was identified in 69 patients (17.6%). Angiographic vasospasm was more frequent as age decreased. Except in patients < 30 years old, the frequency of symptomatic vasospasm also increased with decreasing age (p = 0.0001). After adjusting for variables known to be associated with vasospasm, an advanced age was associated with a reduced incidence of any angiographic vasospasm (OR 0.96, 95% CI 0.94–0.97), severe angiographic vasospasm (OR 0.96, 95% CI 0.95–0.98), and symptomatic vasospasm (OR 0.98, 95% CI 0.96–0.99).

Conclusions

Results in this study show that a younger age is associated with an increased incidence of angiographic and symptomatic vasospasm.

Abbreviations used in this paper:

DIND = delayed ischemic neurological deterioration; ICU = intensive care unit; SAH = subarachnoid hemorrhage; TCD = transcranial Doppler.

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