Abstract Details

Title Predicting Aneurysmal Etiology Using Admission Head CT in Patients with Aneurysmal Pattern Subarachnoid Hemorrhage

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (5:30 PM-6:30 PM)

Poster/Presentation
Number 13-002

Background Spontaneous anSAH represents a diagnostic dilemma as there is no vascular etiology identified and patients may require further imaging and have prolonged hospital stays.

Objective

To determine radiographic predictors of aneurysmal cause based on admission non-contrast head CT in patients with spontaneous angiogram-negative subarachnoid hemorrhage (anSAH).

Design/Methods We performed a retrospective case control study of patients who were admitted for spontaneous subarachnoid hemorrhage (SAH) with suspected aneurysmal etiology to an academic center from 2016 to 2021. Patients with pure convexity SAH were excluded. We compared blood thickness (continuous variable) in the basal cisterns and Sylvian fissures and modified GRAEB scores on admission head CT between aneurysmal and non-aneurysmal groups. We subsequently developed a predictive model to identify aneurysmal etiology.

Results Of 148 included patients (mean age 56 years [SD 12.7]; 55% female, 70% white), 61 were aneurysmal SAH (aSAH) and 87 were anSAH with no vascular etiology. Median modified GRAEB score was higher in aSAH than anSAH (6 [IQR2-10] vs 0 [IQR0-4], p<0.001). Mean blood thickness was greater in the Sylvian fissure (p<0.001), interpeduncular (p=0.005), quadrigeminal (p=0.003), crural (p=0.014), and ambient cisterns (p=0.0015) in aSAH than anSAH, but less in prepontine cistern (p=0.006). Our 8-point scoring model is based on differences in radiographic features. Receiver operating characteristics (ROC) curve analysis showed high accuracy in predicting aneurysmal etiology (area under the curve [AUC] 0.79, 95% CI 0.70-0.88; odds ratio 1.45 per point increase, 95% CI 1.24-1.70; p<0.001).

Conclusions

The proposed scoring tool can aid clinicians in predicting aneurysmal etiology in patients with aneurysmal pattern SAH using measurements from admission head CTs. Eliminating aneurysmal etiology of anSAH earlier may reduce the need for further extensive work up, hospital length of stay, and associated complications, thereby reducing health care related costs. This model needs to be validated in a larger multi-center study.

Authors/Disclosures
Karl V. Baumgartner PRESENTER	Mr. Baumgartner has nothing to disclose.
Aiden Meyer	Mr. Meyer has received research support from Brown University - Undergraduate Teaching and Research Award.
Daniel Mandel, MD	Dr. Mandel has nothing to disclose.
Scott Moody	No disclosure on file
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Jesse Menville	Ms. Menville has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Ali Mahta, MD (Brown University)	Dr. Mahta has nothing to disclose.