Clinical characteristics of aneurysmal subarachnoid hemorrhage in the elderly over 75; would temporal muscle be a potential prognostic factor as an indicator of sarcopenia?

Objectives: Age of patients with subarachnoid hemorrhage (SAH) is increasing. It is challenging to decide whether to perform aneurysm treatment and to predict their prognosis. We assumed that elderly patients with SAH who do not suffer from sarcopenia tend to have good outcomes. Temporal muscle thickness (TMT) and area (TMA) are useful indicators of sarcopenia. We investigated the clinical characteristics, including temporal muscle, in SAH patients over 75 years old. Patients and methods: We retrospectively analyzed 49 SAH patients over 75 years old from 2014 to 2018, who accounted for 37% of the patients in all age group. The correlations between the clinical variables and the modified Rankin Scale (mRS) at discharge were analyzed. Results: Of the all 49 SAH patients over 75 years old, premorbid mRS, WFNS grade, lymphocyte, aneurysm size, TMT, TMA, showed significant correlations with mRS at discharge. Men and the absence of hydrocephalus were correlated with favorable outcomes. Thirteen of the 24 patients over 75 years old whose WFNS grade were I to III but also who underwent aneurysm treatment had favorable outcomes (mRS 0-2), and their standardized TMT divided by height, by weight, and TMA divided by weight were significantly larger than that with poor outcomes. Conclusion: Aneurysm intervention should be considered when patients over 75 years old do not suffer from sarcopenia. Temporal muscle would indicate premorbid mRS and be potentially useful to decide surgical indication and to predict outcome after aneurysm treatment in the elderly.