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Neurocritical Care
Published in: Neurocritical Care 3/2013

01-06-2013 | Original Article

Post-subarachnoid Hemorrhage Vasospasm in Patients with Primary Headache Disorders

Authors: Jason A. Ellis, Hannah Goldstein, Philip M. Meyers, Sean D. Lavine, E. Sander Connolly Jr., Stephan A. Mayer, Neeraj Badjatia, Dorothea Altschul

Published in: Neurocritical Care | Issue 3/2013

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Abstract

Background

Altered cerebral vasomotor reactivity leading to vasospasm can be seen both in patients with primary headache disorders (PHD) and in patients with subarachnoid hemorrhage (SAH). The pathogenesis of vasospasm in post-SAH patients and in headache disorder sufferers may be related. To address this hypothesis, we analyzed a large cohort of SAH patients to determine whether a diagnosis of PHD predisposes to vasospasm, delayed cerebral ischemia, or worsened clinical outcome.

Methods

Prospectively collected data from patients enrolled in the SAH Outcomes Project between 1996 and 2006 were analyzed. Patients were segregated based on whether they had a diagnosis of PHD or not and were subsequently compared for differences in clinical and radiographic outcome.

Results

A total of 921 SAH patients were analyzed, 265 of which had a diagnosis of PHD. In total, symptomatic vasospasm was seen in 17 %, while angiographic vasospasm was seen in 28 %. Vasospasm rates were similar among patients with a PHD and in those without a PHD (p > 0.05). However, on multivariate analysis new ischemic infarcts were more common in patients with a PHD as compared to patients without a PHD (p = 0.015). Functional outcomes at 3 months were similar among PHD and non-PHD patients (p > 0.05).

Conclusion

A history of PHD is associated with an increased rate of ischemic infarcts during admission for SAH. Increased rates of vasospasm within small cerebral blood vessels may be implicated. Further studies are warranted to more closely link the mechanisms of vasospasm in PHD and SAH patients.
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Metadata
Title
Post-subarachnoid Hemorrhage Vasospasm in Patients with Primary Headache Disorders
Authors
Jason A. Ellis
Hannah Goldstein
Philip M. Meyers
Sean D. Lavine
E. Sander Connolly Jr.
Stephan A. Mayer
Neeraj Badjatia
Dorothea Altschul
Publication date
01-06-2013
Publisher
Humana Press Inc
Published in
Neurocritical Care / Issue 3/2013
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-012-9801-2

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