Ahead of Print: Risk Factors for Acute Subdural Hematoma

Background: Acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH), and is associated with poor clinical condition on admission and poor outcome. Risk factors for developing aSDH from aneurysmal rupture are unknown and may help understanding how aSDH develops.

Objective: To identify risk factors for developing aSDH from intracranial aneurysm rupture.

Methods: Patients were selected from our prospectively collected single center SAH database. From all 1757 patients fulfilling pre-specified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, past history of SAH, sentinel headache, location of the ruptured aneurysm and intracerebral hemorrhage (ICH) as risk factors for aSDH. Univariable and multivariable risk ratios (RRs) with corresponding 95% confidence intervals (95%CI) were calculated for characteristics with Poisson regression.

Results: Multivariable RRs were 1.021 (95%CI:1.001-1.042) for each year increase in age, 2.3 (95%CI:1.3-3.8) for Pcom aneurysms, 3.0 (95%CI:1.5-6.0) for sentinel headache, and 5.2 (95%CI:3.1-8.9) for ICH. None of the 95 patients (0%; 95%CI:0-3.8%) with a ruptured vertebrobasilar aneurysm had aSDH, which was statistically significantly lower than at other sites (p=.02 for basilar aneurysm; p=.04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with aSDH.

Conclusion: Increasing age, sentinel headache, ICH and aneurysms at the Pcom are independent risk factors for aSDH. Patients with a basilar or vertebral aneurysm have a low risk for aSDH.

From: Risk Factors for Acute Subdural Hematoma from Intracranial Aneurysm Rupture by Matthijs Biesbroek et al.

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