Aneurysmal subarachnoid hemorrhage: predictive score for angiographic vasospasm

Abstract Aneurysmal subarachnoid hemorrhage is a condition resulting from the rupture of a cerebral aneurysm, sometimes leading to delayed cerebral ischemia, primarily due to angiographic vasospasm; its prediction is crucial to improve patient management and outcomes. To assess the predictive value of clinical, analytical and imaging parameters for vasospasm in aneurysmal subarachnoid hemorrhage and to develop a clinical practical score. The current single-center retrospective study included 115 patients with aneurysmal subarachnoid hemorrhage who underwent a computed tomography scan within 24 hours of ictus. Clinical and analytical data were collected, and Hounsfield unit (HU) measurements were independently assessed. Statistical analyses were conducted to identify predictors of vasospasm. Vasospasm occurred in 40% of patients (46/115). The multivariate analysis identified intracerebral hemorrhage (odds ratio [OR] = 2.482; 95%CI = 1.019–6.046; p = 0.045), interpeduncular HU value (per 5 HU increase: OR = 1.253; 95%CI = 1.044–1.504; p = 0.016), and serum chloride ≥ 106 mEq/L (OR = 3.545; 95%CI = 1.457–8.621; p = 0.005) as independent predictors (p We identified significant predictors of vasospasm in patients with aneurysmal subarachnoid hemorrhage, namely interpeduncular HU value, intracerebral hemorrhage, and serum chloride levels. A practical 5-point score based on these factors offers a potentially-robust, easy-to-use tool for early risk stratification, which may guide personalized follow-up and timely interventions. Further prospective multicenter studies are recommended to validate these findings.