Does aneurysm side influence the infarction side and patients´ outcome after subarachnoid hemorrhage?

Autoři: Nina Brawanski aff001;  Sepide Kashefiolasl aff001;  Sae-Yeon Won aff001;  Stephanie Tritt aff002;  Joachim Berkefeld aff002;  Christian Senft aff001;  Volker Seifert aff001;  Jürgen Konczalla aff001
Působiště autorů: Department of Neurosurgery, Goethe-University Hospital, Frankfurt am Main, Germany aff001;  Institute of Neuroradiology, Goethe- University Hospital, Frankfurt am Main, Germany aff002;  Institute of Neuroradiology, Helios HSK Wiesbaden, Wiesbaden, Germany aff003
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224013



The prognostic factors and outcome of aneurysms appear to be dependent on its locations. Therefore, we compared left- and right- sided aneurysms in patients with aneurysmal subarachnoid hemorrhage (SAH) in terms of differences in outcome and prognostic factors.


Patients with SAH were entered into a prospectively collected database. A total of 509 patients with aneurysmal subarachnoid hemorrhage were retrospectively selected and stratified in two groups depending on side of ruptured aneurysm (right n = 284 vs. left n = 225). Midline aneurysms of the basilar and anterior communicating arteries were excluded from the analysis. Outcomes were assessed using the modified Rankin Scale (mRS; favorable (mRS 0–2) vs. unfavorable (mRS 3–6)) six months after SAH.


We did not identify any differences in outcome depending on left- and right-sided ruptured aneurysms. In both groups, the significant negative predictive factors included clinical admission status (WFNS IV+V), Fisher 3- bleeding pattern in CT, the occurrence of delayed cerebral ischemia (DCI), early hydrocephalus and later shunt-dependence. The side of the ruptured aneurysm does not seem to influence patients´ outcome. Interestingly, the aneurysm side predicts the side of infarction, with a significant influence on patients´ outcome in case of left-sided infarctions. In addition, the in multivariate analysis side of aneurysm was an independent predictor for the side of cerebral infarctions.


The side of the ruptured aneurysms (right or left) did not influence patients’ outcome. However, the aneurysm-side predicts the side of delayed infarctions and outcome appear to be worse in patients with left-sided infarctions.

Klíčová slova:

Aneurysms – Hydrocephalus – Infarction – Left hemisphere – Lesions – Prognosis


1. Abla AA, Wilson DA, Williamson RW, Nakaji P, McDougall CG, Zabramski JM, et al. The relationship between ruptured aneurysm location, subarachnoid hemorrhage clot thickness, and incidence of radiographic or symptomatic vasospasm in patients enrolled in a prospective randomized controlled trial. J Neurosurg. 2014;120: 391–397. doi: 10.3171/2013.10.JNS13419 24313610

2. Konczalla J, Brawanski N, Platz J, Senft C, Kashefiolasl S, Seifert V. Aneurysm location as a prognostic outcome factor after subarachnoid hemorrhage (SAH) from ICA- aneurysms: Implication for translational research—from bedside to bench?! World Neurosurg. 2016;

3. Sposato LA, Cohen G, Wardlaw JM, Sandercock P, Lindley RI, Hachinski V, et al. Effect of Right Insular Involvement on Death and Functional Outcome After Acute Ischemic Stroke in the IST-3 Trial (Third International Stroke Trial). Stroke. 2016;47: 2959–2965. doi: 10.1161/STROKEAHA.116.014928 27895298

4. Sundseth J, Sundseth A, Thommessen B, Johnsen LG, Altmann M, Sorteberg W, et al. Long-term outcome and quality of life after craniectomy in speech-dominant swollen middle cerebral artery infarction. Neurocrit Care. 2015;22: 6–14. doi: 10.1007/s12028-014-0056-y 25127905

5. Konczalla J, Platz J, Brawanski N, Güresir E, Lescher S, Senft C, et al. Endovascular and surgical treatment of internal carotid bifurcation aneurysms: comparison of results, outcome, and mid-term follow-up. Neurosurgery. 2015;76: 540–50; discussion 550–1. doi: 10.1227/NEU.0000000000000672 25635884

6. Konczalla J, Kashefiolasl S, Brawanski N, Senft C, Seifert V, Platz J. Increasing numbers of nonaneurysmal subarachnoid hemorrhage in the last 15 years: antithrombotic medication as reason and prognostic factor? J Neurosurg. 2015; 1–7. doi: 10.3171/2015.5.JNS15161 26566212

7. Konczalla J, Brawanski N, Bruder M, Senft C, Platz J, Seifert V. Outcome of Patients with Long-Lasting Cerebral Vasospasm After Subarachnoid Hemorrhage: Is Prolonged Treatment for Cerebral Vasospasm Worthwhile? A Matched-Pair Analysis. World Neurosurg. 2016;88: 488–96. doi: 10.1016/j.wneu.2015.10.033 26498398

8. Vergouwen MDI, Vermeulen M, van Gijn J, Rinkel GJE, Wijdicks EF, Muizelaar JP, et al. Definition of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage as an Outcome Event in Clinical Trials and Observational Studies: Proposal of a Multidisciplinary Research Group. Stroke. 2010;41: 2391–2395. doi: 10.1161/STROKEAHA.110.589275 20798370

9. Stienen MN, Fung C, Bijlenga P, Zumofen DW, Maduri R, Robert T, et al. Measuring the Impact of Delayed Cerebral Ischemia on Neuropsychological Outcome After Aneurysmal Subarachnoid Hemorrhage-Protocol of a Swiss Nationwide Observational Study (MoCA-DCI Study). Neurosurgery. 2019;84: 1124–1132. doi: 10.1093/neuros/nyy155 29762759

10. Starnoni D, Maduri R, Hajdu SD, Pierzchala K, Giammattei L, Rocca A, et al. Early Perfusion Computed Tomography Scan for Prediction of Vasospasm and Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. World Neurosurg. 2019; doi: 10.1016/j.wneu.2019.06.213 31284055

11. Jaja BNR, Cusimano MD, Etminan N, Hanggi D, Hasan D, Ilodigwe D, et al. Clinical Prediction Models for Aneurysmal Subarachnoid Hemorrhage: A Systematic Review. Neurocrit Care. 2013;18: 143–153. doi: 10.1007/s12028-012-9792-z 23138544

12. Pegoli M, Mandrekar J, Rabinstein AA, Lanzino G. Predictors of excellent functional outcome in aneurysmal subarachnoid hemorrhage. J Neurosurg. 2015;122: 414–418. doi: 10.3171/2014.10.JNS14290 25495745

13. Stienen MN, Smoll NR, Fung C, Goldberg J, Bervini D, Maduri R, et al. Home-Time as a Surrogate Marker for Functional Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke. 2018;49: 3081–3084. doi: 10.1161/STROKEAHA.118.022808 30735342

14. Zumofen DW, Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, et al. Factors associated with clinical and radiological status on admission in patients with aneurysmal subarachnoid hemorrhage. Neurosurg Rev. 2018;41: 1059–1069. doi: 10.1007/s10143-018-0952-2 29428981

15. Lagares A, Gómez PA, Lobato RD, Alén JF, Alday R, Campollo J. Prognostic factors on hospital admission after spontaneous subarachnoid haemorrhage. Acta Neurochir (Wien). 2001;143: 665–72.

16. Wong GKC, Nung RCH, Sitt JCM, Mok VCT, Wong A, Ho FLY, et al. Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage. Stroke. 2015;46: 3099–3104. doi: 10.1161/STROKEAHA.115.010844 26419967

17. Neidert MC, Maldaner N, Stienen MN, Roethlisberger M, Zumofen DW, D’Alonzo D, et al. The Barrow Neurological Institute Grading Scale as a Predictor for Delayed Cerebral Ischemia and Outcome After Aneurysmal Subarachnoid Hemorrhage: Data From a Nationwide Patient Registry (Swiss SOS). Neurosurgery. 2018;83: 1286–1293. doi: 10.1093/neuros/nyx609 29351673

18. Stone SP, Halligan PW, Greenwood RJ. The incidence of neglect phenomena and related disorders in patients with an acute right or left hemisphere stroke. Age Ageing. 1993;22: 46–52. doi: 10.1093/ageing/22.1.46 8438666

19. Macciocchi SN, Diamond PT, Alves WM, Mertz T. Ischemic stroke: relation of age, lesion location, and initial neurologic deficit to functional outcome. Arch Phys Med Rehabil. 1998;79: 1255–7. doi: 10.1016/s0003-9993(98)90271-4 9779680

20. Naidech AM, Bendok BR, Bassin SL, Bernstein RA, Batjer HH, Bleck TP. CLASSIFICATION OF CEREBRAL INFARCTION AFTER SUBARACHNOID HEMORRHAGE IMPACTS OUTCOME. Neurosurgery. 2009;64: 1052–1058. doi: 10.1227/01.NEU.0000343543.43180.9C 19487883

21. Rabinstein AA, Friedman JA, Weigand SD, McClelland RL, Fulgham JR, Manno EM, et al. Predictors of Cerebral Infarction in Aneurysmal Subarachnoid Hemorrhage. Stroke. 2004;35: 1862–1866. doi: 10.1161/01.STR.0000133132.76983.8e 15218156

22. Rosenberg NF, Liebling SM, Kosteva AR, Maas MB, Prabhakaran S, Naidech AM. Infarct Volume Predicts Delayed Recovery in Patients with Subarachnoid Hemorrhage and Severe Neurological Deficits. Neurocrit Care. 2013;19: 293–298. doi: 10.1007/s12028-013-9869-3 23860664

23. HECAEN H. [The clinical symptomatology of right and left hemispheric lesions]. Cah Coll Med Hop Paris. 1962;3: 259–70. 13905821

24. Cutting J. Study of anosognosia. J Neurol Neurosurg Psychiatry. 1978;41: 548–55. doi: 10.1136/jnnp.41.6.548 671066

25. Fullerton KJ, McSherry D, Stout RW. Albert’s test: a neglected test of perceptual neglect. Lancet (London, England). 1986;1: 430–2.

26. Cifu DX, Lorish TR. Stroke rehabilitation. 5. Stroke outcome. Arch Phys Med Rehabil. 1994;75: S56–60. 8185465

27. Lehmann JF, DeLateur BJ, Fowler RS, Warren CG, Arnhold R, Schertzer G, et al. Stroke rehabilitation: Outcome and prediction. Arch Phys Med Rehabil. 1975;56: 383–9. 809023

28. Alexander MP. Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care. Stroke. 1994;25: 128–34. doi: 10.1161/01.str.25.1.128 8266360

29. Schaapsmeerders P, van Uden IWM, Tuladhar AM, Maaijwee NAM, van Dijk EJ, Rutten-Jacobs LCA, et al. Ipsilateral hippocampal atrophy is associated with long-term memory dysfunction after ischemic stroke in young adults. Hum Brain Mapp. 2015;36: 2432–42. doi: 10.1002/hbm.22782 25757914

30. Stienen MN, Germans M, Burkhardt J-K, Neidert MC, Fung C, Bervini D, et al. Predictors of In-Hospital Death After Aneurysmal Subarachnoid Hemorrhage. Stroke. 2018;49: 333–340. doi: 10.1161/STROKEAHA.117.019328 29335333

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2019 Číslo 11