Risk Factors Associated With Acute And Chronic Hydrocephalus In Aneurysmal Subarachnoid Hemorrhage

OBJECT:Hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage(aSAH).A large proportion of patients need shunt for permanent cerebrospinal fluid metastasis.However,due to the interaction of multiple factors in patients'condition,the specific mechanism is still unclear.The research results of the research centers are different.Previously identified risk factors included age,sex,Hunt-Hess score,Glasgow Coma Scale(GCS),intraventricular hemorrhage(IVH),Fisher grade,aneurysm location and treatment.We will retrospectively analyze the clinical data of related patients,analyze the correlation of the above factors in hydrocephalus at different stages after subarachnoid hemorrhage,and further clarify the risk factors.METHOD:The clinical data of 153 patients with spontaneous subarachnoid hemorrhage(SAH)from January 2016 to January 2019 in the Department of Neurology,Qianfoshan Hospital Affiliated to Shandong University,according to a retrospective analysis of spontaneous subarachnoid hemorrhage The occurrence of hydrocephalus was divided into acute hydrocephalus group(Al:70 cases),chronic hydrocephalus group(A2:49 cases),and non-brain hydrops group(B:71 cases).According to the risk factors of hydrocephalus proposed in the relevant literature and the characteristics of the clinical cases we collected,the risk factors of hydrocephalus in this paper(Age,Gender,Hypertension,Hunt-Hess classification at admission,Ventricular hemorrhage,Fisher score,Location of aneurysm,Treatment,etc.)were determined.Firstly,the univariate analysis and comparison of chi-square test were used to study the differences of related risk factors between acute hydrocephalus group,chronic hydrocephalus group and non-hydrocephalus group,and then statistically significant factors were analyzed by logistic regression analysis.Add to determine.Result:1.In the acute hydrocephalus group,70 cases were treated with EVD after admission.37 cases were converted to chronic hydrocephalus,6 cases died and 26 cases were significantly improved.Among them,2 cases had intracranial infection(cured by active treatment).In the chronic hydrocephalus group,49 cases were treated with craniotomy,17 cases had chosen to clip aneurysms,and 24 cases had chosen hemorrhage.Interventional embolization was performed in 8 patients.Among them,11 patients were treated conservatively.Their clinical symptoms improved significantly and their lives basically returned to normal.22 patients had mild disability,11 patients had moderate or above disability,and 5 patients died clinically.2.Statistical analysis of acute hydrocephalus group and non-brain hydrops group:age(P(0.03)<0.05),number of SAH,ventricular hemorrhage,Fisher score,Hunt-Hess grade(P(0.000)<0.05)The combined hematoma(P(0.001)<0.05)was statistically different from the non-hydrocephalus group;there was no statistical difference in gender,hypertension,and aneurysm position.3.Statistical analysis of chronic hydrocephalus group and non-hydrocephalus group:SAH times,ventricular hemorrhage,Fisher score,acute hydrocephalus,Hunt-Hess grade(P(0.000)<0.05),combined hematoma(P(0.004)<0.05),aneurysm position(P(0.042)<0.05)7 cases were statistically different from non-hydrocephalus group;there was no statistical difference in gender,age,hypertension and treatment.Conclusion:1.Our clinical treatment found that if any of the following conditions occur in the acute stage of SAH,ventricular drainage should be performed immediately:(1)severe hydrocephalus was detected on CT scans;(2)pernventricular edema;or(3)hydrocephalus with deterioration of consciousness after eliminating re-hemorrhage.For patients with mild or moderate hydrocephalus without obvious clinical symptoms,repetitive CT scan can be performed after close monitoring for 48 hours.Patients with improved hydrocephalus and clinically stable patients without further ventricular enlargement should be continuously monitored.2.The pathogenesis of acute hydrocephalus is thought to be due to blocked cerebrospinal fluid flow,which creates a pressure gradient that eventually leads to enlargement of the ventricles,while the pathogenesis of chronic hydrocephalus involves arachnoid adhesions due to the reaction of the meninges to blood components.Damage to the absorption of cerebrospinal fluid in the basal pool.In this study,the incidence of acute hydrocephalus was 45.7%,the incidence of chronic hydrocephalus was 32%,and 52%of patients in the acute hydrocephalus group switched to chronic hydrocephalus.Acute hydrocephalus was associated with age,number of SAH,ventricular hemorrhage,Fisher score,Hunt-Hess classification,hematoma associated with chronic hydrocephalus and SAH,ventricular hemorrhage,Fisher score,acute hydrocephalus,Hunt-Hess Classification,hematoma,location of aneurysms and other factors are related,the frequence of SAH increases the risk of hydrocephalus after subarachnoid hemorrhage.3.Hydrocephalus can lead to long-term cognitive decline and the development of psychiatric diseases,requiring early identification and treatment;Compared with endplate fenestration and lumbar peritoneal shunt,ventriculo-peritoneal shunt is still a safe and effective treatment;Simply implementing EVD may not reduce the risk of hydrocephalus and need to strengthen management during EVD;The use of repetitive lumbar puncture or lumbar puncture drainage may be beneficial to remove subarachnoid hemorrhage.Blood clots help reduce the risk of hydrocephalus.