ABSTRACT
Objective Spontaneous subarachnoid hemorrhage (SAH) is a neurological condition that causes significant morbidity and mortality. It is known to have regional differences in its incidence. Indian studies have shown conflicting results about the incidence of aneurysms as the cause of SAH, varying from 35% to 80%. The data available on the epidemiology of spontaneous SAH in the South Indian population are very few. Our study aims to describe the clinical profile of patients presenting with spontaneous SAH to the emergency department in a tertiary center in South India and describe the factors influencing the clinical outcome. Materials and Methods The study included 75 patients diagnosed with spontaneous SAH in our emergency department. Demographic data, medical history, details about the first medical contact, clinical features at admission, complications during the hospital stay, and interventions underwent were recorded. The study participants were followed-up at 6 weeks after discharge from hospital to assess the neurological outcome based on modified Rankin Scale (mRS) score, using a 9-point questionnaire. Results Of the 75 patients with spontaneous SAH, the majority were females, and in the age group of 50 to 69 years. The median time to first medical contact was observed to be 2 hours; and SAH was diagnosed at the first medical contact only in 37% of the patients. Hypertension was the most common comorbid condition associated with SAH (53%). Almost 80% of the patients who underwent angiographic studies had aneurysmal SAH (aSAH). Hydrocephalus was the most common complication seen in 37% of the patients, followed by hyponatremia (28%) and vasospasm (25%). At the time of follow-up after 6 weeks, we found that 36% of the patients were having a neurologically favorable outcome with an mRS score of 0 to 2, 8% of patients were having moderate to severe disability (mRS 3 to 5) and were living a dependent life. The mortality rate (mRS 6) was observed to be around 50% (6% lost to follow-up). Conclusion We observed a relatively higher incidence of aneurysmal rupture among the patients with spontaneous SAH in our region. The misdiagnosis rate at first medical contact was higher. The mortality rate was observed to be around 50% at 6 weeks. Loss of consciousness at ictus, aneurysmal rupture, WFNS grades IV-V, hydrocephalus, vasospasm, hypernatremia, and delayed cerebral ischemia were found to be the mortality predictors in SAH.
ABSTRACT
BACKGROUND: Arachnoid cysts constitute a mere 1% of all nontraumatic intracranialspace-occupying lesions, and only 10% of these are present in theinfratentorial compartment. We hereby report a case of a 10-month-old femalechild with a tricompartmental arachnoid cyst. CASE DESCRIPTION: The arachnoid cyst spanned both the infratentorial and supratentorialcompartment of the intracranial space. In addition, the cyst was alsoherniating into the extracranial compartment through a congenital defect in theparietal bone. The child was brought to us with a disfiguring swelling over herscalp, which was progressively increasing in size. We managed the patient byexcision of the extracranial part and placed a cystoperitoneal shunt to take care of the intracranial part. Follow-up magneticresonance imaging after 6 months of intervention showed a significant reductionin the size of the intracranial portion of the cyst with no recurrence of theextracranial part. CONCLUSIONS: This case of arachnoid cyst involves multiplestructures. But interestingly, all these structures (arachnoid, dura, veins,and bone) are of mesodermal origin. So we would like to suggest that thispathology may be a result of developmental deviation during mesodermal differentiationrather than a simple expanding arachnoid cyst.
