Acute Hydrocephalus and Cerebral Perfusion after Aneurysmal Subarachnoid Hemorrhage

OBJECTIVEDiverse treatment results are observed in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Significant initial perfusion compromise is thought to predict a worse treatment outcome, but this has scant support in the literature. In this cohort study, the authors correlate the treatment outcomes with a novel poor-outcome imaging predictor representing impaired cerebral perfusion on initial CT angiography (CTA).METHODSThe authors reviewed the treatment results of 148 patients with poor-grade aSAH treated at a single tertiary referral center between 2007 and 2016. Patients with the “venous delay” phenomenon on initial CTA were identified. The outcome assessments used the modified Rankin Scale (mRS) at the 3rd month after aSAH. Factors that may have had an impact on outcome were retrospectively analyzed.RESULTSCompared with previously identified outcome predictors, the venous delay phenomenon on initial CTA was found to have the strongest correlation with posttreatment outcomes on both univariable (p < 0.0001) and multivariable analysis (OR 4.480, 95% CI 1.565–12.826; p = 0.0052). Older age and a higher Hunt and Hess grade at presentation were other factors that were associated with poor outcome, defined as an mRS score of 3 to 6.CONCLUSIONSThe venous delay phenomenon on initial CTA can serve as an imaging predictor for worse functional outcome and may aid in decision making when treating patients with poor-grade aSAH.

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Size of third and fourth ventricle in obstructive and communicating acute hydrocephalus after aneurysmal subarachnoid hemorrhage

Journal of Neurology ◽

10.1007/s00415-010-5678-1 ◽

2010 ◽

Vol 258 (1) ◽

pp. 44-49 ◽

Cited By ~ 9

Author(s):

D. S. Knol ◽

J. van Gijn ◽

C. L. J. J. Kruitwagen ◽

G. J. E. Rinkel

Keyword(s):

Subarachnoid Hemorrhage ◽

Fourth Ventricle ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Acute Hydrocephalus

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Positron Emission Tomographic Cerebral Perfusion Disturbances and Transcranial Doppler Findings among Patients with Neurological Deterioration after Subarachnoid Hemorrhage

Neurosurgery ◽

10.1093/neurosurgery/52.5.1017 ◽

2003 ◽

Vol 52 (5) ◽

pp. 1017-1024 ◽

Cited By ~ 7

Author(s):

Pawan S. Minhas ◽

David K. Menon ◽

Piotr Smielewski ◽

Marek Czosnyka ◽

Peter J. Kirkpatrick ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Carotid Artery ◽

Cerebral Perfusion ◽

Internal Carotid ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Neurological Deficits ◽

Positron Emission Tomographic ◽

Positron Emission ◽

Arterial Vasospasm ◽

The Mean

Abstract OBJECTIVE After aneurysmal subarachnoid hemorrhage, approximately 30% of patients experience delayed neurological deficits, related in part to arterial vasospasm and dysautoregulation. Transcranial Doppler (TCD) ultrasonography is commonly used to noninvasively detect arterial vasospasm. We studied cerebral perfusion patterns and associated TCD indices for 25 patients who developed clinical signs of delayed neurological deficits. METHODS Patients were treated in a neurosurgical intensive care unit and were studied if they exhibited delayed focal or global neurological deterioration. Positron emission tomographic cerebral blood flow (CBF) studies and TCD studies measuring the mean flow velocity (FV) of the middle cerebral artery and the middle cerebral artery FV/internal carotid artery FV ratio (with the internal carotid artery FV being measured extracranially at the cranial base) were performed. Glasgow Outcome Scale scores were assessed at 6 months. RESULTS A markedly heterogeneous pattern of CBF distribution was observed, with hyperemia, normal CBF values, and reduced flow being observed among patients with delayed neurological deficits. TCD indices were not indicative of the cerebral perfusion findings. The mean CBF value was slightly lower for patients who did not survive (32.3 ml/100 g/min), compared with those who did survive (36.0 ml/100 g/min, P= 0.05). CONCLUSION Among patients who developed delayed neurological deficits after aneurysmal subarachnoid hemorrhage, a wide range of cerebral perfusion disturbances was observed, calling into question the traditional concept of large-vessel vasospasm. Commonly used TCD indices do not reflect cerebral perfusion values.

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Are Optimal Cerebral Perfusion Pressure and Cerebrovascular Autoregulation Related to Long-term Outcome in Patients With Aneurysmal Subarachnoid Hemorrhage?

Journal of Neurosurgical Anesthesiology ◽

10.1097/ana.0b013e318224030a ◽

2012 ◽

Vol 24 (1) ◽

pp. 3-8 ◽

Cited By ~ 45

Author(s):

Frank Anthony Rasulo ◽

Alan Girardini ◽

Andrea Lavinio ◽

Elena De Peri ◽

Roberto Stefini ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Perfusion Pressure ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Term Outcome ◽

Long Term Outcome ◽

Cerebrovascular Autoregulation ◽

Optimal Cerebral Perfusion Pressure

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Comparison of cerebral perfusion in perimesencephalic subarachnoid hemorrhage and aneurysmal subarachnoid hemorrhage

Neuroradiology ◽

10.1007/s00234-018-1997-1 ◽

2018 ◽

Vol 60 (6) ◽

pp. 609-616 ◽

Cited By ~ 3

Author(s):

Isabel Fragata ◽

Nuno Canto-Moreira ◽

Patrícia Canhão

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Perfusion ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Perimesencephalic Subarachnoid Hemorrhage

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Pulmonary function and radiographic abnormalities related to neurological outcome after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/jns.1998.88.1.0028 ◽

1998 ◽

Vol 88 (1) ◽

pp. 28-37 ◽

Cited By ~ 43

Author(s):

Andreas Gruber ◽

Andrea Reinprecht ◽

Harald Görzer ◽

Peter Fridrich ◽

Thomas Czech ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Lung Injury ◽

Pulmonary Function ◽

Neurological Outcome ◽

Cerebral Perfusion ◽

Perfusion Pressure ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Medical Complications ◽

Content Type ◽

Fine Print

Object. This observational study is based on a consecutive series of 207 patients with aneurysmal subarachnoid hemorrhage who were treated within 7 days of their most recent bleed. The purpose of the study was to evaluate the effect of respiratory failure on neurological outcome. Methods. Pulmonary function was assessed by determination of parameters describing pulmonary oxygen transport and exchange, by using composite scores for quantification of lung injury (lung injury score [LIS]) and mechanical ventilator settings (PIF score). Pulmonary function was related to the Hunt and Hess (H & H) grade assigned to the patient at hospital admission (p < 0.001). The pattern and time course of lung injury differed significantly between patients with H & H Grade I or II, Grade III, and Grade IV or V. Hunt and Hess grade, Fisher computerized tomography grade, intracranial pressure, cerebral perfusion pressure, LIS, ratio of PaO2 to the fraction of inspired oxygen (FiO2), and the ratio of the alveolar-minus-arterial oxygen tension difference (AaDO2) to FiO2 were related to neurological outcome (p < 0.001). The LIS on the day of maximum lung injury remained an independent predictor of outcome (p = 0.01) in a stepwise logistic regression analysis. The probability of poor neurological outcome significantly increased with both decreasing cerebral perfusion pressure and increasing severity of lung injury. Conclusions. The overall mortality rate was 22.2% (46 of 207 patients). Subarachnoid hemorrhage and its neurological sequelae accounted for the principal mortality in this series. Medical (nonneurological and nontreatment-related) complications accounted for 37% of all deaths. Systemic inflammatory response syndrome with associated multiple organ dysfunction syndrome was the leading cause of death from medical complications. The authors conclude that respiratory failure is related to neurological outcome, although it is not commonly the primary cause of death from medical complications.

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