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Risk Factors for Acute Subdural Hematoma From Intracranial Aneurysm Rupture

Biesbroek, J. Matthijs MD*; Rinkel, Gabriel J.E. MD*; Algra, Ale MD*,‡; van der Sprenkel, Jan Willem Berkelbach MD, PhD*

doi: 10.1227/NEU.0b013e318256c27d
Research-Human-Clinical Studies

BACKGROUND: An acute subdural hematoma (aSDH) is a rare complication of aneurysmal subarachnoid hemorrhage (SAH) and is associated with poor clinical condition on admission and poor outcome. Risk factors for the development of an aSDH from aneurysmal rupture are unknown and may help our understanding of how an aSDH develops.

OBJECTIVE: To identify risk factors for the development of an aSDH from intracranial aneurysm rupture.

METHODS: Patients were selected from our prospectively collected single-center SAH database. From all 1757 patients fulfilling prespecified inclusion criteria, 63 had an aSDH. We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH. Univariable and multivariable risk ratios with corresponding 95% confidence intervals (CIs) were calculated for characteristics with Poisson regression.

RESULTS: Multivariable risk ratios were 1.021 (95% CI: 1.001-1.042) for each year increase in age, 2.3 (95% CI: 1.3-3.8) for posterior communicating artery aneurysms, 3.0 (95% CI: 1.5-6.0) for sentinel headache, and 5.2 (95% CI: 3.1-8.9) for ICH. None of the 95 patients (0%; 95% CI: 0%-3.8%) with a ruptured vertebrobasilar aneurysm had an aSDH, which was statistically significantly lower than at other sites (P = .02 for basilar aneurysm; P = .04 for vertebral aneurysm). None of the other studied characteristics had a statistically significant association with an aSDH.

CONCLUSION: Increasing age, sentinel headache, ICH, and aneurysms at the posterior communicating artery are independent risk factors for an aSDH. Patients with a basilar or vertebral aneurysm have a low risk of an aSDH.

ABBREVIATIONS: AComA, anterior communicating artery

aSDH, acute subdural hematoma

CI, confidence interval

GOS, Glasgow Outcome Scale

ICH, intracerebral hemorrhage

PComA, posterior communicating artery

RR, risk ratio

SAH, subarachnoid hemorrhage

*Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands

Correspondence: J. Matthijs Biesbroek, MD, Department of Neurology, University Medical Center Utrecht, Heidelberglaan 100, Room G03.232, 3508 GA Utrecht, the Netherlands. E-mail:

Received November 4, 2011

Accepted March 7, 2012

Copyright © by the Congress of Neurological Surgeons