Subarachnoid hemorrhage of unknown origin. A 44 cases study

Area of Science:

• Neurology
• Neurosurgery
• Radiology

Background:

• Subarachnoid hemorrhage (SAH) of unknown origin presents diagnostic and therapeutic challenges.
• Understanding the characteristics and outcomes of cryptogenic SAH is crucial for patient management.

Purpose of the Study:

• To investigate the clinical features, diagnostic findings, and treatment outcomes of patients with subarachnoid hemorrhage of unknown origin.
• To evaluate the safety and efficacy of antifibrinolytic therapy in this patient cohort.

Main Methods:

• Retrospective analysis of 44 patients diagnosed with subarachnoid hemorrhage (SAH) without a clear identified cause.
• Clinical data, including age, sex, consciousness level, and comorbidities like hypertension, were collected.
• Diagnostic imaging (CT, angiography) and lumbar puncture findings were reviewed. Treatment protocols, including antifibrinolytic agents and calcium entry-blockers, were assessed.

Main Results:

• The study included 44 patients (20 men, 24 women) with a mean age of 54.1 years, with the highest incidence in the 51-70 age group.
• Vascular hypertension was present in 45.5% of patients, but outcomes were similar between hypertensive and normotensive groups.
• All patients showed typical CT findings of SAH; angiography was normal in all cases. Transient hydrocephalus occurred in 22.7% of patients.
• Antifibrinolytic therapy was administered to approximately 70% of patients, with no observed ischemic complications or rebleeding.
• Follow-up over 7-88 months revealed complete recovery and return to work for all subjects, with no mortality.

Conclusions:

• Subarachnoid hemorrhage of unknown origin, despite potential comorbidities like hypertension, can be managed effectively with a favorable prognosis.
• Antifibrinolytic therapy, with or without calcium entry-blockers, appears safe and effective in preventing complications like rebleeding and ischemic events in this population.
• Patients with cryptogenic SAH demonstrate a high rate of complete recovery and successful return to work, underscoring the importance of timely diagnosis and appropriate management.