[Delayed ischemic neurological deficit that developed over 15 days after subarachnoid hemorrhage]

We retrospectively studied subarachnoid hemorrhage (SAH) patients with delayed ischemic neurological deficit (DIND), and analyzed the factors causing extremely late onset of deficits occurring over 15 days after onset of the SAH. Among 605 patients with SAH, 201 (33%) developed DIND. Among DIND patients, 137 had undergone early aneurysm surgery. In these 137 patients, onset date of DIND was definite in 131 patients. Six patients (5%) developed DIND over 15 days after SAH. All 6 had asymptomatic angiographical vasospasm and infections, most often meningitis, before the onset of DIND. Compared with cases in which there was ordinary onset of DIND, other statistically significant factors among these 6 patients were intracerebral hemorrhage, sepsis and meningitis. We suspect that DIND were manifested subclinically in the early period because of the associated hyperdynamic hemodynamics resulting from sepsis in these patients.