Infarct Volume Predicts Delayed Recovery in Patients with Subarachnoid Hemorrhage and Severe Neurological Deficits

Rosenberg, Neil; Liebling, Storm; Kosteva, Adam; Maas, Matthew B.; Naidech, Andrew M.

doi:10.1007/s12028-013-9869-3

Cited by 8 publications

(6 citation statements)

References 38 publications

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“…Both the articles suggested that multiple infarcts were associated with poor outcome. A quantitative assessment of DCI was attempted by Rosenberg et al 13 They performed a volumetric assessment of DCI in patients with SAH who were dependent or bedbound and showed that infarct volume were associated with outcome. These 3 studies, however, did not further assess the infarct load according to vascular territories.…”

Section: Discussionmentioning

confidence: 99%

“…10,11 In a post hoc path analysis, DCI also had a direct effect on outcome independent of angiographic vasospasm. 12 Although some studies suggested deep DCI and high infarct volume were poor prognostic factors, 7,8,13 the literature was unclear on the outcome impact of quantitative DCI load according to location. These knowledge would help us to understand better the pathological process and assess the severity of delayed cerebral ischemia.…”

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confidence: 99%

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Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

Wong

Nung

Sitt

et al. 2015

Stroke

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We prospectively enrolled patients with SAH presenting to an academic neurosurgical referral center (Prince of Wales Hospital, the Chinese University of Hong Kong) in Hong Kong during a 3-year period. Joint CUHK-NTEC Clinical Research Ethics Committee approved the study. This study conformed to the Declaration of Helsinki and written informed consent was obtained from all the participants or their next of kin.The patient inclusion criteria were (1) spontaneous SAH with angiography-confirmed intracranial aneurysms; (2) hospital admission Background and Purpose-Aneurysmal subarachnoid hemorrhage is a serious disease with high case fatality and morbidity.Delayed cerebral infarction (DCI) is an important surrogate marker. How location and infarct load affected outcomes was unclear. We aimed to assess the effects of load and location of DCI on outcomes of aneurysmal subarachnoid hemorrhage at 3 months. Methods-We prospectively enrolled patients with subarachnoid hemorrhage presenting to an academic neurosurgical unit in Hong Kong during a 3-year period. DCI was defined by new hypoattenuation on computed tomography at 4 to 6 weeks, which was not present in the postaneurysm-treatment computed tomography at 24 to 48 hours. DCI was assessed for location according to cerebral artery territories and load semiquantitatively. Cognitive and functional outcome assessments were carried out 3 months after ictus. Results-One hundred twenty-six patients with subarachnoid hemorrhage consented for this study. DCI occurred in 56 (44%) patients and was associated with poorer cognitive and functional outcomes (Montreal Cognitive Assessment, MiniMental State Examination, modified Rankin Scale, and Lawton Instrumental Activity of Daily Living) at 3 months. In patients with DCI, the presence of perforator zone infarct was associated with poorer cognitive and functional outcomes, and cortical middle cerebral artery infarct was associated with poorer modified Rankin Scale. After adjustment for age, admission World Federation of Neurosurgical Societies Grade and mode of aneurysm treatment, both middle cerebral artery cortical infarct load and perforator infarct load were independently associated with poor cognitive outcomes (Montreal Cognitive Assessment and Mini-Mental State Examination) and modified Rankin Scale. Conclusions-Middle cerebral artery cortical and perforator zone infarct loads are potential surrogate marker to assess the severity of delayed cerebral ischemia.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

Wong

Nung

Sitt

et al. 2015

Stroke

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“…CT scans were routinely performed on admission and postoperatively, with repeated CTs obtained when clinically indicated. Using such a strategy might create detection bias if patients in worse clinical condition receive more frequent imaging and had infarcts detected earlier [23]. For the same reason, asymptomatic infarctions might be underestimated.…”

Section: Study Limitationsmentioning

confidence: 99%

Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage

Jabbarli

Reinhard

Niesen

et al. 2015

Euro J of Neurology

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“…This might have led to a detection bias in favor of patients with worse clinical condition, as well as underestimation of asymptomatic infarctions. 39 However we consider that such infarct monitoring was sufficient for the current study goal, as all included patients had at least one follow-up CT scan. Furthermore, we included CT scans up to 6 weeks after SAH to cover the crucial time for CI occurrence.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Early Identification of Individuals at High Risk for Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage: The BEHAVIOR Score

Jabbarli

Reinhard

Roelz

et al. 2015

J Cereb Blood Flow Metab

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Cerebral infarction (CI) is a crucial complication of aneurysmal subarachnoid hemorrhage (SAH) associated with poor clinical outcome. We aimed at developing an early risk score for CI based on clinical characteristics available at the onset of SAH. Out of a database containing 632 consecutive patients with SAH admitted to our institution from January 2005 to December 2012, computed tomography (CT) scans up to day 42 after ictus were evaluated for CIs. Different parameters from admission up to aneurysm treatment were collected with subsequent construction of a risk score. Seven clinical characteristics were independently associated with CI and included in the Risk score (BEHAVIOR Score, 0 to 11 points): Blood on CT scan according to Fisher grade ⩾3 (1 point), Elderly patients (age ⩾55 years, 1 point), Hunt&Hess grade ⩾4 (1 point), Acute hydrocephalus requiring external liquor drainage (1 point), Vasospasm on initial angiogram (3 points), Intracranial pressure elevation >20 mm Hg (3 points), and treatment of multiple aneurysms ('Overtreatment', 1 point). The BEHAVIOR score showed high diagnostic accuracy with respect to the absolute risk for CI (area under curve=0.806, P<0.0001) and prediction of poor clinical outcome at discharge (P<0.0001) and after 6 months (P=0.0002). Further validation in other SAH cohorts is recommended.

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Infarct Volume Predicts Delayed Recovery in Patients with Subarachnoid Hemorrhage and Severe Neurological Deficits

Abstract: After SAH, even with severe neurological injury at 14 days, good recovery is frequent and is associated with lower infarction volume. These data may help clinicians inform surrogate decision makers as they plan the future care of such severely disabled patients.

Cited by 8 publications

References 38 publications

Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage

Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage

Early Identification of Individuals at High Risk for Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage: The BEHAVIOR Score

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