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Hemorragia subaracnoidea perimesencefálica aneurismática versus "benigna"
Anas Alrohimi1,2, Mark A Davison1, Abhi Pandhi1
1Cerebrovascular Center Neurologic Institute Cleveland Clinic Foundation Cleveland OH United States.
Stroke (Hoboken, N.J.)
|January 26, 2026
Resumen
La hemorragia subaracnoidea perimesencefálica puede implicar aneurismas rotos en el 6,2 % de los casos, a menudo detectados mediante angiografía cerebral. Los aneurismas subyacentes, la hidrocefalia y el vasoespasmo sintomático se asocian con peores resultados.
Área de la Ciencia:
- Neurología
- Neurocirugía
- Radiología
Sus antecedentes:
- La hemorragia subaracnoidea perimesencefálica (HSAP) a menudo se considera benigna, pero los datos sobre aneurismas rotos subyacentes y complicaciones son limitados.
- La comprensión de estos factores es crucial para optimizar el manejo y los resultados del paciente.
Objetivo del estudio:
- Investigar la tasa de aneurismas rotos subyacentes en la HSAP.
- Identificar complicaciones comunes y su asociación con los resultados del paciente.
- Evaluar la importancia clínica de la hidrocefalia y el vasoespasmo en la HSAP.
Principales métodos:
- Análisis retrospectivo de 81 pacientes diagnosticados con HSAP entre 2007 y 2022.
- Revisión de imágenes diagnósticas, incluida la angiotomografía computarizada y la angiografía por sustracción digital.
- Evaluación de complicaciones como vasoespasmo e hidrocefalia.
- Evaluación del estado funcional utilizando la escala de Rankin modificada.
Principales resultados:
- Se identificó un aneurisma roto subyacente en el 6,2 % de los pacientes, y el 3,7 % requirió angiografía cerebral para su detección.
- El vasoespasmo ocurrió en el 31 % de los pacientes, predominantemente asintomático (84 %). El vasoespasmo sintomático fue más frecuente en pacientes con aneurismas (40 % frente al 2,6 %).
- La hidrocefalia ocurrió en el 10 % de los pacientes, todos dentro de las 24 horas. El estado funcional deficiente (escala de Rankin modificada 0-2) se asoció con aneurismas subyacentes, hidrocefalia y vasoespasmo sintomático.
Conclusiones:
- La HSAP se asocia con aneurismas subyacentes en un pequeño porcentaje de casos, lo que requiere una evaluación angiográfica exhaustiva.
- La hidrocefalia y el vasoespasmo sintomático son predictores significativos de malos resultados.
- La HSAP no aneurismática sin hidrocefalia puede permitir una monitorización menos intensiva y estancias hospitalarias más cortas.
Palabras clave:
aneurismaangiografía por sustracción digitalhidrocefaliahemorragia subaracnoidea perimesencefálicavasoespasmoMás Videos Relacionados
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