Increase in Brain Volume After Aneurysmal Subarachnoid Hemorrhage Leads to Unfavorable Outcome: A Retrospective Study Quantified by CT Scan

Background and Purpose: Primary brain swelling occurs in aneurysmal subarachnoid hemorrhage (aSAH) patients. The absence of a dynamic quantitative method restricts further study of primary brain swelling. This study compared differences in the change rate of brain volume (CRBV) between patients with and without primary brain swelling in the early stage of aSAH. Moreover, the relationship between CRBV and clinical outcomes was evaluated.Methods: Patients hospitalized within 24 h after aSAH were included in this retrospective study. Utilizing a qualitative standard established before the study to recognize primary brain swelling through brain CT after aSAH, clinical outcomes after 3 months of SAH were evaluated with a modified Rankin scale (mRS). The brain volume (BV) of each patient was calculated with a semiautomatic threshold algorithm of 3D-slicer, and the change in brain volume (CIBV) was obtained by subtracting the two extreme values (CIBV = BVmax – BVmin). The CRBV was obtained by CIBV/BVmin × 100%. The CRBV values that predicted unfavorable prognoses were estimated.Results: In total, 130 subjects were enrolled in the study. The mean CRBV in the non-swelling group and swelling group were 4.37% (±4.77) and 11.87% (±6.84), respectively (p < 0.05). CRBV was positively correlated with the length of hospital stay, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume (Spearman ρ = 0.334; p < 0.001; Pearson ρ = 0.269, p = 0.002; Pearson ρ = 0.278, p = 0.001; Pearson ρ = 0.233, p = 0.008, respectively). Analysis of variance showed significant differences in CIBV, CRBV, blood in the ambient cistern, blood in the lateral ventricle, and lateral ventricular volume among varying modified Fisher scale (mFisher), with higher admission mFisher scale, indicating larger values of these variables. After adjusting for risk factors, the model showed that for every 1% increase in the CRBV, the probability of poor clinical prognosis increased by a factor of 1.236 (95% CI = 1.056–1.446). In the stratified analysis, the odds of worse clinical outcomes increased with increases in the CRBV. Receiver operating characteristic curve analysis showed that HH grade, mFisher scale, and score of CRBV (SCRBV) had diagnostic performance for predicting unfavorable clinical outcomes.Conclusion: Primary brain swelling increases brain volume after aSAH. The CRBV quantified by 3D-Slicer can be used as a volumetric representation of the degree of brain swelling. A larger CRBV in the early stage of aSAH is associated with poor prognosis. The CRBV can be used as a neuroimaging biomarker of early brain injury after bleeding and may be an effective predictor of patients' clinical prognoses.

Download Full-text

Spontaneous Hypocapnea In Patients With Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study To Determine Incidence And Associations With Clinical Outcomes

10.1164/ajrccm-conference.2010.181.1_meetingabstracts.a3028 ◽

2010 ◽

Author(s):

Othman Solaiman ◽

Jeffrey M. Singh

Keyword(s):

Retrospective Study ◽

Subarachnoid Hemorrhage ◽

Clinical Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage

Download Full-text

Faculty Opinions recommendation of Hypocapnia in aneurysmal subarachnoid hemorrhage: incidence and association with poor clinical outcomes.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718021964.793479047 ◽

2013 ◽

Author(s):

John Andrzejowski

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage

Download Full-text

Alanine Aminotransferase Predicts Outcomes in Elderly Patients with Aneurysmal Subarachnoid Hemorrhage

Current Neurovascular Research ◽

10.2174/1567202616666190130094631 ◽

2019 ◽

Vol 16 (1) ◽

pp. 89-95

Author(s):

Jianfeng Zheng ◽

Rui Xu ◽

Zongduo Guo ◽

Xiaochuan Sun

Keyword(s):

Subarachnoid Hemorrhage ◽

Elderly Patients ◽

Clinical Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Laboratory Data ◽

Cardiac Complications ◽

World Population ◽

Systemic Complications ◽

Poor Outcome ◽

Poor Outcomes

Objective: With the aging of the world population, the number of elderly patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) is gradually growing. We aim to investigate the potential association between plasma ALT level and clinical complications of elderly aSAH patients, and explore its predictive value for clinical outcomes of elderly aSAH patients. Methods: Between January 2013 and March 2018, 152 elderly aSAH patients were analyzed in this study. Clinical information, imaging findings and laboratory data were reviewed. According to the Glasgow Outcome Scale (GOS), clinical outcomes at 3 months were classified into favorable outcomes (GOS 4-5) and poor outcomes (GOS 1-3). Logistic regression analysis was used to assess the indicators associated with poor outcomes, and receiver curves (ROC) and corresponding area under the curve (AUC) were used to detect the accuracy of the indicator. Results: A total of 48 (31.6 %) elderly patients with aSAH had poor outcome at 3 months. In addition to ICH, IVH, Hunt-Hess 4 or 5 Grade and Modified Fisher 3 or 4 Grade, plasma ALT level was also strongly associated with poor outcome of elderly aSAH patients. After adjusting for other covariates, plasma ALT level remained independently associated with pulmonary infection (OR 1.05; 95% CI 1.00–1.09; P = 0.018), cardiac complications (OR 1.05; 95% CI 1.01–1.08; P = 0.014) and urinary infection (OR 1.04; 95% CI 1.00–1.08; P = 0.032). Besides, plasma ALT level had a predictive ability in the occurrence of systemic complications (AUC 0.676; 95% CI: 0.586– 0.766; P<0.001) and poor outcome (AUC 0.689; 95% CI: 0.605–0.773; P<0.001) in elderly aSAH patients. Conclusion: Plasma ALT level of elderly patients with aSAH was significantly associated with systemic complications, and had additional clinical value in predicting outcomes. Given that plasma ALT levels on admission could help to identify high-risk elderly patients with aSAH, these findings are of clinical relevance.

Download Full-text

Association between HbA1C (glycated hemoglobin) and clinical outcomes in patients with subarachnoid hemorrhage after neuro-intervention

Current Neurovascular Research ◽

10.2174/1567202618666210225103057 ◽

2021 ◽

Vol 18 ◽

Author(s):

Chan Woong Park ◽

Ho Jun Yi ◽

Dong Hoon Lee ◽

Jae Hoon Sung

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcome ◽

Clinical Outcomes ◽

Glycated Hemoglobin ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Roc Curve Analysis ◽

Optimal Cutoff ◽

Cutoff Value ◽

Unfavorable Clinical Outcome ◽

High Hba1c

Objective: Our study investigated the association between level of HbA1c (glycated hemoglobin) at admission and the prognosis of aneurysmal subarachnoid hemorrhage (SAH). Methods: A total of 510 patients treated with neuro-intervention for aneurysmal SAH and with data for admission HbA1c (glycated hemoglobin) were included. Favorable clinical outcome was defined as Modified Rankin Scale (mRS) score of 0–2 at 3 months. Receiver operating characteristic (ROC) curve analysis was used to identify the optimal cutoff value of HbA1C for unfavorable clinical outcomes. Logistic regression was used to evaluate the association between HbA1C level and outcomes. Results: The optimal cutoff value of HbA1C was identified as 6.0% (P < 0.001), and patients with a high HbA1C (≥ 6.0%) had a lower prevalence of favorable clinical outcomes than patients with low HbA1C (< 6.0%) (P < 0.001). High HbA1C (≥ 6.0%) was independently associated with unfavorable clinical outcome (OR 2.84; 95% CI: 1.52-5.44; P = 0.004). The risk of unfavorable clinical outcome was significantly increased in patients with HbA1C (≥ 7.0%, < 8%) and HbA1C (≥ 8.0%) compared with lower baseline HbA1C (≥ 6.0%, < 7%) values (OR 2.17; 95% CI: 1.87-5.13; P = 0.011 and OR 4.25; 95% CI: 3.17-8.41; P = 0.005). Conclusions: Our study showed that HbA1C could be an independent predictor of worse outcome following neuro-intervention for aneurysmal SAH. High HbA1C (≥ 6.0%) was associated with unfavorable clinical outcome, and gradual elevation of HbA1C contributed to an increase in the risk of worse clinical outcome after SAH.

Download Full-text

Association of APOE Polymorphism with the Change of Brain Function in the Early Stage of Aneurysmal Subarachnoid Hemorrhage

Early Brain Injury or Cerebral Vasospasm ◽

10.1007/978-3-7091-0353-1_7 ◽

2011 ◽

pp. 39-42 ◽

Cited By ~ 2

Author(s):

Bin Lin ◽

Wei Dan ◽

Li Jiang ◽

Xiao-hong Yin ◽

Hai-tao Wu ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Brain Function ◽

Early Stage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Apoe Polymorphism

Download Full-text

Early prediction of clinical outcomes in patients with aneurysmal subarachnoid hemorrhage using computed tomography texture analysis

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2019.08.098 ◽

2020 ◽

Vol 71 ◽

pp. 144-149 ◽

Cited By ~ 1

Author(s):

Tokunori Kanazawa ◽

Satoshi Takahashi ◽

Yasuhiro Minami ◽

Masahiro Jinzaki ◽

Masahiro Toda ◽

...

Keyword(s):

Computed Tomography ◽

Subarachnoid Hemorrhage ◽

Texture Analysis ◽

Clinical Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Early Prediction

Download Full-text

Correlation Between ED Symptoms and Clinical Outcomes in the Patient with Aneurysmal Subarachnoid Hemorrhage

Journal of Emergency Nursing ◽

10.1016/j.jen.2010.09.003 ◽

2012 ◽

Vol 38 (3) ◽

pp. 226-233 ◽

Cited By ~ 3

Author(s):

Kristin Adkins ◽

Elizabeth Crago ◽

Chien-Wen J. Kuo ◽

Michael Horowitz ◽

Paula Sherwood

Keyword(s):

Subarachnoid Hemorrhage ◽

Clinical Outcomes ◽

Aneurysmal Subarachnoid Hemorrhage

Download Full-text

Anesthesia modality does not affect clinical outcomes of intra-arterial vasodilator treatment in patients with symptomatic cerebral vasospasms

F1000Research ◽

10.12688/f1000research.52324.2 ◽

2021 ◽

Vol 10 ◽

pp. 417

Author(s):

Corinne Fischer ◽

Sonja Vulcu ◽

Johannes Goldberg ◽

Franca Wagner ◽

Belén Rodriguez ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

General Anesthesia ◽

Clinical Outcomes ◽

Cerebral Vasospasm ◽

Conscious Sedation ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Vasodilator Therapy ◽

Significant Difference ◽

Vasodilator Treatment

Background: Delayed cerebral ischemia and cerebral vasospasm remain the leading causes of poor outcome in survivors of aneurysmal subarachnoid hemorrhage. Refractory cerebral vasospasms can be treated with endovascular vasodilator therapy, which can either be performed in conscious sedation or general anesthesia. The aim of this study is to compare the effect of the anesthesia modality on long-term clinical outcomes in patients undergoing endovascular vasodilator therapy due to cerebral vasospasm and hypoperfusion. Methods: Modified Rankin Scale (mRS) scores were retrospectively analyzed at time of discharge from the hospital and six months after aneurysmal subarachnoid hemorrhage. Additionally, National Institutes of Health Stroke Scale (NIHSS) was assessed 24 hours before, immediately before, immediately after, and 24 hours after endovascular vasodilator therapy, and at discharge and six months. Interventional parameters such as duration of intervention, choice and dosage of vasodilator and number of arteries treated were also recorded. Results: A total of 98 patients were included in this analysis and separated into patients who had interventions in conscious sedation, general anesthesia and a mix of both. Neither mRS at discharge nor at six months showed a significant difference for functionally independent outcomes (mRS 0-2) between groups. NIHSS before endovascular vasodilator therapy was significantly higher in patients receiving interventions in general anesthesia but did not differ anymore between groups six months after the initial bleed. Conclusion: This study did not observe a difference in outcome whether patients underwent endovascular vasodilator therapy in general anesthesia or conscious sedation for refractory cerebral vasospasms. Hence, the choice should be made for each patient individually.

Download Full-text