• Matthew J Kole, Phelan Shea, Jennifer S Albrecht, Gregory J Cannarsa, Aaron P Wessell, Timothy R Miller, Gaurav Jindal, Dheeraj Gandhi, E Francois Aldrich, and J Marc Simard.
• Department of Neurosurgery, School of Medicine, University of Maryland, Baltimore, Maryland.
• Neurosurgery. 2020 Jun 1; 86 (6): 783-791.

BackgroundSubarachnoid hemorrhage (SAH) is most commonly caused by a ruptured vascular lesion. A significant number of patients presenting with SAH have no identifiable cause despite extensive cerebrovascular imaging at presentation. Significant neurological morbidity or mortality can result from misdiagnosis of aneurysm.ObjectiveTo generate a model to assist in predicting the risk of aneurysm in this patient population.MethodsWe conducted a retrospective study of all patients aged ≥18 yr admitted to a single center from March 2008 to March 2018 with nontraumatic SAH (n = 550). Patient information was compared between those with and without aneurysm to identify potential predictors. Odds ratios obtained from a logistic regression model were converted into scores which were summed and tested for predictive ability.ResultsFemale sex, higher modified Fisher or Hijdra score, nonperimesencephalic location, presence of intracerebral hemorrhage, World Federation of Neurosurgical Societies (WFNS) score ≥3, need for cerebrospinal fluid diversion on admission, and history of tobacco use were all entered into multivariable analysis. Greater modified Fisher, greater Hijdra score, WFNS ≥3, and hydrocephalus present on admission were significantly associated with the presence of an aneurysm. A model based on the Hijdra score and SAH location was generated and validated.ConclusionWe show for the first time that the Hijdra score, in addition to other factors, may assist in identifying patients at risk for aneurysm on cerebrovascular imaging. A simple scoring tool based on patient sex, SAH location, and SAH burden can assist in predicting the presence of an aneurysm in patients with nontraumatic SAH.Copyright © 2019 by the Congress of Neurological Surgeons.

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