Predictors of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: A multivariable analysis of 506 patients.

Authors

• Basel Musmar
• Victor Gabriel El-Hajj
• Joanna M Roy
• Hammam Abdalrazeq
• Pious Patel
• Michael Baldassari
• Matthews Lan
• Anthony Yulin Chen
• Mary-Katharine Pontarelli
• Shray Patel
• Arbaz Momin
• Michael Rizzuto
• Stavropoula I Tjoumakaris
• Michael Reid Gooch
• Robert H Rosenwasser
• Pascal Jabbour

Publication/Presentation Date

9-11-2026

Abstract

BACKGROUND: Cerebral vasospasm (CVS) is a major contributor to delayed cerebral ischemia and poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). We aimed to identify independent predictors of CVS in a large contemporary aSAH cohort.

METHODS: We retrospectively reviewed 506 adult patients with aSAH treated at a single tertiary center. Univariable and multivariable logistic regression were performed to identify independent predictors of CVS.

RESULTS: Among 506 patients with aSAH, 90 (17.7%) developed cerebral vasospasm. Patients who developed vasospasm were younger than those without vasospasm (50.43 ± 12.87 vs. 55.36 ± 13.11 years; p = 0.001) and more frequently had modified Fisher grade 4, prior ischemic stroke, and decompressive hemicraniectomy (all p ≤ 0.001). On multivariable analysis, younger age (< 52 years), decompressive hemicraniectomy, and hydrocephalus were independently associated with any vasospasm. Modified Fisher grade 3 and 4 showed borderline associations with any vasospasm (p <  0.10). For clinically significant (symptomatic) vasospasm, prior ischemic stroke and modified Fisher grade 3 and 4 were independently associated with increased odds of symptomatic vasospasm.

CONCLUSION: In this multivariable analysis of 506 aSAH patients, On multivariable analysis, younger age (< 52 years), decompressive hemicraniectomy, and hydrocephalus were independently associated with any vasospasm, while prior ischemic stroke and higher modified Fisher grade (grades 3 and 4) were independently associated with clinically significant vasospasm. These factors may help inform early risk stratification and targeted monitoring.

Volume

490

First Page

126172

Last Page

126172

ISSN

1878-5883

Published In/Presented At

Musmar, B., El-Hajj, V. G., Roy, J. M., Abdalrazeq, H., Patel, P., Baldassari, M., Lan, M., Chen, A. Y., Pontarelli, M. K., Patel, S., Momin, A., Rizzuto, M., Tjoumakaris, S. I., Gooch, M. R., Rosenwasser, R. H., & Jabbour, P. (2026). Predictors of cerebral vasospasm after aneurysmal subarachnoid hemorrhage: A multivariable analysis of 506 patients. Journal of the neurological sciences, 490, 126172. Advance online publication. https://doi.org/10.1016/j.jns.2026.126172

PubMedID

42732765

Department(s)

Administration and Leadership, Department of Surgery

Document Type

Article