The impact of meningeal syndrome on the course of aneurysmal subarachnoid hemorrhage

Abstract

Purpose: to assess the impact of meningeal syndrome on the course of aneurysmal subarachnoid hemorrhage (aSAH). Materials and methods. The study included 480 clinical records of the acute period following intracranial aneurysm (ICA) rupture. Patients were divided into two groups: group 1 – patients without meningeal signs, group 2 – patients with meningeal signs. Statistical analysis was performed using the χ²-test, independent samples t-test, Mann-Whitney test, binomial logistic and ordinal regression. Results. The relative number of patients with grade 1 of the modified WFNS scale was higher in the first group. Meanwhile, patients in the second group had twice the likelihood of a worse severity level on the modified WFNS scale upon admission (OR=2.16; CI 0.193–1.38; p=0.011). Headache was present in 44 patients (83.0%) of the first group and in 365 patients (86.1%) of the second group (χ²=0.362; df=1; p=0.547). Vasospasm was detected in 22 patients (41.5%) in group 1 and in 202 patients (47.5%) in group 2 (χ²=0.686; df=1; p=0.408). Hydrocephalus developed in 3 patients (5.7%) from the first group and in 72 patients (16.9%) from the second group. Binomial logistic regression analysis revealed that patients with meningeal signs had a threefold increased likelihood of developing hydrocephalus after aSAH (OR=3.3803; CI 1.0260–11.136; p=0.045). Conclusions. Meningeal signs serve as a direct prognostic indicator of outcomes after aSAH based on their impact on the severity of the patient’s condition upon admission. Meningeal syndrome is an unfavorable clinical indicator regarding the development of hydrocephalus in patients during the acute period following ICA rupture.