Amount of blood on computed tomography as an independent predictor after aneurysm rupture.

Brouwers, P. J. A. M.; Dippel, Diederik W.J.; Vermeulen, M.; Lindsay, Kenneth W.; Hasan, D.; Gijn, J. van

doi:10.1161/01.str.24.6.809

Cited by 148 publications

(87 citation statements)

References 28 publications

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“…2 It occurs in approximately one third of patients, mostly between the fourth and the tenth days after the hemorrhage. 3,4 Independent predictors for DCI are the neurological condition on admission and the amount of extravasated blood on the initial CT. [5][6][7] In a recent study, we also found that cerebral perfusion on the admission CT is a strong predictor for the development of DCI. 8 Because it is plausible that acute hydrocephalus has a negative influence on the cerebral perfusion, hydrocephalus on the admission scan may be a risk factor for DCI as well.…”

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confidence: 71%

Extent of Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage as a Risk Factor for Delayed Cerebral Infarction

Bakker

Mees

Algra

et al. 2007

Stroke

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Background and Purpose-Delayed cerebral infarction (DCI) is an important cause of poor outcome after subarachnoid hemorrhage. Cerebral perfusion is a predictor for DCI. Because acute hydrocephalus may impair cerebral perfusion, we evaluated the predictive value of the extent of acute hydrocephalus on the development of DCI. Methods-We retrieved data on 321 patients admitted within 4 days after aneurysmal subarachnoid hemorrhage from our prospectively collected database. Ventricular enlargement was quantified by measuring the bicaudate index and the width of the third ventricle. Ventricular sizes were analyzed as continuous variables and after categorization into quartiles. The relationship between these variables and the development of DCI was analyzed by means of the Cox proportional hazards model. Results-DCI occurred in 76 patients (23.7%). Hazard ratios for occurrence of DCI of the continuous variables were 1.01 (95% CI: 0.97 to 1.06) for the bicaudate index, 1.00 (95% CI: 1.00 to 1.01) for the age-adjusted bicaudate index, and 0.99 (95% CI: 0.92 to 1.06) for the width of the third ventricle in univariable analysis. The adjusted hazard ratio for the highest quartile of the bicaudate index versus the lowest quartile was 0.9 (95% CI: 0.5 to 1.8). No linear trend could be recognized in consecutive quartiles. Conclusions-Acute hydrocephalus is not a risk factor for occurrence of DCI, even when the extent of hydrocephalus is taken into account. However, we cannot exclude the possibility that extensive hydrocephalus leading to coma does increase the risk for DCI if no therapeutic intervention were done.

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confidence: 71%

Extent of Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage as a Risk Factor for Delayed Cerebral Infarction

Bakker

Mees

Algra

et al. 2007

Stroke

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“…[3][4][5][6]9,10,[18][19][20][22][23][24][25][27][28][29][30][31]33,[35][36][37]39,41 Ten studies were excluded because they did not evaluate aneurysm diameter as a risk factor for rehemorrhage rate. 4,6,9,18,22,24,29,36,39,41 Two other articles were excluded because one was a review and the other was an editorial. 25,36 One study was written in Japanese and was thus also excluded.…”

Section: Results Included Studiesmentioning

confidence: 99%

Aneurysm diameter as a risk factor for pretreatment rebleeding: a meta-analysis

Boogaarts¹,

Lieshout²,

Amerongen

et al. 2015

JNS

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OBJECT Aneurysmal rerupture prior to treatment is a major cause of death and morbidity in aneurysmal subarachnoid hemorrhage. Recognizing risk factors for aneurysmal rebleeding is particularly relevant and might help to identify the aneurysms that benefit from acute treatment. It is uncertain if the size of the aneurysm is related to rebleeding. This meta-analysis was performed to evaluate whether an association could be determined between aneurysm diameter and the rebleeding rate before treatment. Potentially confounding factors such age, aneurysm location, and the presence of hypertension were also evaluated. METHODS The authors systematically searched the PubMed, Embase, and Cochrane databases up to April 3, 2013, for studies of patients with aneurysmal subarachnoid hemorrhage that reported the association between aneurysm diameter and pretreatment aneurysmal rebleeding. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were used to evaluate study quality. RESULTS Seven studies, representing 2121 patients, were included in the quantitative analysis. The quality of the studies was low in 2 and very low in 5. Almost all of the studies used 10 mm as the cutoff point for size among other classes, and only one used 7 mm. An analysis was performed with this best unifiable cutoff point. Overall rebleeding occurred in 360 (17.0%) of 2121 patients (incidence range, from study to study, 8.7%–28.4%). The rate of rebleeding in small and large aneurysms was 14.0% and 23.6%, respectively. The meta-analysis of the 7 studies revealed that larger size aneurysms were at a higher risk for rebleeding (OR 2.56 [95% CI 1.62–4.06]; p = 0.00; I2 = 60%). The sensitivity analysis did not alter the results. Five of the 7 studies reported data regarding age; 4 studies provided age-adjusted results and identified a persistent relationship between lesion size and the risk of rebleeding. The presence of hypertension was reported in two studies and was more prevalent in patients with rebleeding in one of these. Location (anterior vs posterior circulation) was reported in 5 studies, while in 4 there was no difference in the rebleeding rate. One study identified a lower risk of rebleeding associated with posterior location aneurysms. CONCLUSIONS This meta-analysis showed that aneurysm size is an important risk factor for aneurysmal rebleeding and should be used in the clinical risk assessment of individual patients. The authors' results confirmed the current guidelines and underscored the importance of acute treatment for large ruptured aneurysms.

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“…[5][6][7][8][9][10] Thick subarachnoid clot on admission CT has been associated with the development of DCI after SAH. [5][6][7][8][9][11][12][13][14][15][16][17][18][19][20] The Fisher CT grading scale, 21 which evaluates the amount of cisternal blood and the presence of intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH), is widely used in the United States to identify patients at high risk for the development of DCI. Although the Fisher scale identifies patients with thick cisternal blood (grade 3), it does not differentiate between ICH and IVH (both grade 4), nor does it consider the potential for higher risk in patients with thick cisternal and ventricular or parenchymal blood.…”

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confidence: 99%

Effect of Cisternal and Ventricular Blood on Risk of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage:

Claassen

Bernardini²,

Kreiter³

et al. 2001

Stroke

647

465

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Background and Purpose-Thick cisternal clot on CT is a well-recognized risk factor for delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH). Whether intraventricular hemorrhage (IVH) or intracerebral hemorrhage (ICH) predisposes to DCI is unclear. The Fisher CT grading scale identifies thick SAH but does not separately account for IVH or ICH. Methods-We studied 276 consecutively admitted patients with an available admission CT scan performed within 72 hours of onset. Demographic, clinical, laboratory, and neuroimaging data were recorded, and the amount and location of SAH, IVH, and ICH on admission CT scans were quantified. The relationship between these variables and DCI was analyzed separately and in combination with multiple logistic regression. Results-DCI developed in 20% of patients (54 of 276). Among SAH variables, thick clot completely filling any cistern or fissure was the best predictor of DCI (Pϭ0.008), and among IVH variables, blood in both lateral ventricles was most predictive (Pϭ0.001). These variables had independent predictive value for DCI in a multivariate analysis of CT findings, and both were included in a final multivariate model when evaluated in conjunction with other clinical risk factors: IVH (OR 4.1, 95% CI 1.7 to 9.8), SAH (OR 2.3, 95% CI 1.5 to 9.5), mean arterial pressure Ͼ112 mm Hg (OR 4.9, 95% CI 2.1 to 11.4), and transcranial Doppler mean velocity Ͼ140 cm/s within 5 days of hemorrhage (OR 3.8, 95% CI 1.5 to 9.5). Similar results were obtained in a repeat analysis with infarction due to vasospasm as the dependent variable. Conclusions-SAH completely filling any cistern or fissure and IVH in the lateral ventricles are both risk factors for DCI, and their risk is additive. We propose a new SAH rating scale that accounts for the independent predictive value of subarachnoid and ventricular blood for DCI.

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Amount of blood on computed tomography as an independent predictor after aneurysm rupture.

Cited by 148 publications

References 28 publications

Extent of Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage as a Risk Factor for Delayed Cerebral Infarction

Extent of Acute Hydrocephalus After Aneurysmal Subarachnoid Hemorrhage as a Risk Factor for Delayed Cerebral Infarction

Aneurysm diameter as a risk factor for pretreatment rebleeding: a meta-analysis

Effect of Cisternal and Ventricular Blood on Risk of Delayed Cerebral Ischemia After Subarachnoid Hemorrhage:

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