Factors associated with hydrocephalus after aneurysmal subarachnoid hemorrhage

OBJECTIVE: Associations among various factors and the occurrence of hydroce phalus after aneurysmal subarachnoid hemorrhage (SAH) were evaluated retros pectively in 897 patients enrolled in the North American study of tirilazad mesylate. METHODS: patients were assessed for hydrocephalus in a blinded fashion. Ass essment of hydrocephalus was made on the basis of 3-month follow-up compute d tomographic studies or, for those without a S-month follow-up scan, on th e basis of the latest computed tomographic studies obtained at least 10 day s after SAH. Criteria indicating the occurrence of hydrocephalus were the p resence of significantly enlarged temporal horns or prior placement of a ve ntricular shunt. Univariate analysis was performed to assess relationships among various factors and hydrocephalus. if actors statistically associated with the occurrence of hydrocephalus were analyzed further using logistic regression analysis. RESULTS: Overall, 25.9% of the 897 patients developed hydrocephalus. Statis tically significant associations among the following factors and hydrocepha lus were observed (P value; risk coefficient): 1) severity of 3-month post- SAH Glasgow Outcome Scale (0.0001; 2.00); 2) increased ventricular size at admission (0.0001; 2.78); 3) neurological grade severity at admission (0.02 74; 1.26); 4) preexisting hypertension (0.0284; 1.66); 5) alcoholism (0.006 6; 2.30); 6) female sex (0.0056; 0.49); 7) increased aneurysm size (0.0239; 0.56); 8) pneumonia (0.0299; 1.78); 9) meningitis (0.0290; 5.86); and 10) intraventricular hemorrhage at admission (0.0414; 1.64). CONCLUSION: Hydrocephalus seems to have a multifactorial etiology. Knowledg e of risk factors related to the occurrence of hydrocephalus may help guide neurosurgeons in the long-term care of patients who have experienced aneur ysmal SAH.