Non‐aneurysmal subarachnoid hemorrhage in 173 patients: a prospective study of long‐term outcome

Background and purpose In some patients with subarachnoid hemorrhage ( SAH ) a bleeding source cannot be identified. Perimesencephalic ( PM ) SAH is assumed to have an excellent outcome. Our objective was to analyze the long‐term physical and psychological outcome of patients after non‐aneurysmal SAH . Methods One hundred and seventy‐three patients met the inclusion criteria. Short‐term follow‐up 6 months after SAH was assessed according to the modified Rankin Scale (0–2 favorable). A short‐form health survey with 36 questions ( SF ‐36) and eight scales was used as questionnaire for long‐term follow‐up. Results Thirty‐seven answers were received from the two groups, PM and non‐perimesencephalic ( NPM ) SAH , on average 76 months after ictus (range 1.5–14 years). PM ‐ and NPM ‐ SAH without Fisher grade 3 blood pattern have excellent short‐term outcomes. The quality of life (QoL) is significantly reduced after non‐aneurysmal SAH , especially in NPM ‐ SAH . In particular, patients with a Fisher 3 blood pattern had significantly higher risks for cerebral vasospasm, delayed cerebral ischaemia, unfavorable outcome, reduced QoL and mortality in short‐ and long‐term follow‐up. Conclusions Excluding rolph, only patients with a PM ‐ SAH have a similar QoL at long‐term follow‐up compared to the standard population. Patients with NPM ‐ SAH have a significantly decreased QoL in long‐term follow‐up. Furthermore, the Fisher 3 blood pattern group in particular had a significantly worse outcome − at short‐term and long‐term follow‐up. Therefore the NPM ‐ SAH group was stratified into patients with Fisher 3 blood pattern and patients without Fisher 3 in further investigations.