Application of Near-Infrared Spectroscopy for the Detection of Delayed Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage

2021 ◽  
Author(s):  
Indu Kapoor ◽  
Charu Mahajan ◽  
Hemanshu Prabhakar
Keyword(s):  
Infrared Spectroscopy ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Delayed Cerebral Ischemia ◽  
Poor Grade

scholarly journals Monitoring of Delayed Cerebral Ischemia in Patients with Subarachnoid Hemorrhage via Near-Infrared Spectroscopy

2020 ◽  
Vol 9 (5) ◽  
pp. 1595
Author(s):  
Jeong Jin Park ◽  
Chulho Kim ◽  
Jin Pyeong Jeon
Keyword(s):  
Infrared Spectroscopy ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Diagnostic Accuracy ◽  
Near Infrared Spectroscopy ◽  
Doppler Ultrasonography ◽  
Near Infrared ◽  
Delayed Cerebral Ischemia ◽  
Feasible Method

We investigated the role of near infrared spectroscopy (NIRS) in identifying delayed cerebral ischemia (DCI) in patients with subarachnoid hemorrhage (SAH). We measured the cerebral regional oxygen saturation (rSO2) continuously for 14 days. The differences in rSO2 according to DCI were analyzed. We also compared the diagnostic accuracy of NIRS and transcranial Doppler ultrasonography (TCD) for DCI detection using the area under receiver operator characteristic (ROC) curve. Fifty-two patients treated with coil embolization were enrolled, including 18 with DCI (34.6%) and 34 without DCI (65.4%). Significant differences in rSO2 levels were observed from days 7 to 9. The rSO2 level was 60.95 (58.10–62.30) at day 7 in the DCI vs. 63.90 (62.50–67.10) in the non-DCI patients. By day 8, it was 59.50 (56.90–64.50) in the DCI vs. 63.30 (59.70–68.70) in the non-DCI cases. By day 9, it was 61.85 (59.40–65.20) in the DCI vs. 66.00 (62.70–68.30) in the non-DCI. A decline of >12.7% in SO2 rate yielded a sensitivity of 94.44% (95% CI: 72.7–99.9%) and a specificity of 70.59% (95% CI: 52.5–84.9%) for identifying DCI. Changes in NIRS tended to yield better diagnostic accuracy than TCD, but were not statistically significant. NIRS is a feasible method for real-time detection of DCI.

Defining thresholds for critical ischemia by using near-infrared spectroscopy in the adult brain

1998 ◽  
Vol 89 (3) ◽  
pp. 389-394 ◽  
Author(s):  
Peter J. Kirkpatrick ◽  
Joseph Lam ◽  
Pippa Al-Rawi ◽  
Piotr Smielewski ◽  
Marek Czosnyka
Keyword(s):  
Infrared Spectroscopy ◽  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Adult Brain ◽  
Content Type ◽  
Signal Changes ◽  
Fine Print

Object. Signal changes in adult extracranial tissues may have a profound effect on cerebral near-infrared spectroscopy (NIRS) measurements. During carotid surgery NIRS signals provide the opportunity to determine the relative contributions from the intra- and extracranial vascular territories, allowing for a more accurate quantification. In this study the authors applied multimodal monitoring methods to patients undergoing carotid endarterectomy and explored the hypothesis that NIRS can define thresholds for cerebral ischemia, provided extracranial NIRS signal changes are identified and removed. Relative criteria for intraoperative severe cerebral ischemia (SCI) were applied to 103 patients undergoing carotid endarterectomy. Methods. One hundred three patients underwent carotid endarterectomy. An intraoperative fall in transcranial Doppler—detected middle cerebral artery flow velocity (%ΔFV) of greater than 60% accompanied by a sustained fall in cortical electrical activity were adopted as criteria for SCI. Ipsilateral frontal NIRS recorded the total difference in concentrations of oxyhemoglobin and deoxyhemoglobin (Total ΔHbdiff). Interrupted time series analysis following clamping of the external carotid artery (ECA) and the internal carotid artery (ICA) allowed the different vascular components of Total ΔHbdiff (ECA ΔHbdiff and ICA ΔHbdiff) to be identified. Data obtained in 76 patients were deemed suitable. A good correlation between %ΔFV and ICA ΔHbdiff (r = 0.73, p < 0.0001) was evident. Sixteen patients (21%) fulfilled the criteria for SCI. All patients who demonstrated an ICA ΔHbdiff of greater than 6.8 µmol/L showed SCI, and in two patients within this group nondisabling watershed infarction developed, as seen on postoperative computerized tomography scans. No patient with an ICA ΔHbdiff less than 5 µmol/L exhibited SCI or suffered a stroke. Within the resolution of the criteria used an ICA ΔHbdiff threshold of 6.8 µmol/L provided 100% specificity for SCI, whereas an ICA ΔHbdiff less than 5 µmol/L was 100% sensitive for excluding SCI. When Total ΔHbdiff was used without removing the ECA component, no thresholds for SCI were apparent. Conclusions. Carotid endarterectomy provides a stable environment for exploring NIRS-quantified thresholds for SCI in the adult head.

Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage

2008 ◽  
Vol 109 (6) ◽  
pp. 1052-1059 ◽  
Author(s):  
J. Michael Schmidt ◽  
Katja E. Wartenberg ◽  
Andres Fernandez ◽  
Jan Claassen ◽  
Fred Rincon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Ischemia ◽  
Cerebral Infarction ◽  
Clinical Symptoms ◽  
External Ventricular Drain ◽  
Delayed Cerebral Ischemia ◽  
Neurological Deterioration ◽  
Modified Rankin Scale ◽  
Poor Grade

Object The authors sought to determine frequency, risk factors, and impact on outcome of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage (SAH). Methods The authors prospectively studied 580 patients with SAH admitted to their center between July 1996 and May 2002. Delayed cerebral ischemia (DCI) from vasospasm was defined as 1) a new focal neurological deficit or decrease in level of consciousness, 2) a new infarct revealed by follow-up CT imaging, or both, after excluding causes other than vasospasm. Outcome at 3 months was assessed using the modified Rankin Scale. Results Delayed cerebral ischemia occurred in 121 (21%) of 580 patients. Of those with DCI, 36% (44 patients) experienced neurological deterioration without a corresponding infarct, 42% (51 patients) developed an infarct in conjunction with neurological deterioration, and 21% (26 patients) had a new infarct on CT without concurrent neurological deterioration. In a multivariate analysis, risk factors for asymptomatic DCI included coma on admission, placement of an external ventricular drain, and smaller volumes of SAH (all p ≤ 0.03). Patients with asymptomatic DCI were less likely to be treated with vasopressor agents than those with symptomatic DCI (64 vs 86%, p = 0.01). After adjusting for clinical grade, age, and aneurysm size, the authors found that there was a higher frequency of death or moderate-to-severe disability at 3 months (modified Rankin Scale Score 4–6) in patients with asymptomatic DCI than in patients with symptomatic DCI (73 vs 40%, adjusted odds ratio 3.9, 95% confidence interval 1.3–12.0, p = 0.017). Conclusions Approximately 20% of episodes of DCI after SAH are characterized by cerebral infarction in the absence of clinical symptoms. Asymptomatic DCI is particularly common in comatose patients and is associated with poor outcome. Strategies directed at diagnosing and preventing asymptomatic infarction from vasospasm in patients with poor-grade SAH are needed.

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