Initial Loss of Consciousness and Risk of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Hop, Jeannette W.; Rinkel, G. J. E.; Algra, Ale; Gijn, J. van

doi:10.1161/01.str.30.11.2268

Cited by 130 publications

(62 citation statements)

References 28 publications

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“…Thirty-three studies (63%) were rated as HQ. [9][10][11][12][13]15,16,[18][19][20]22,[28][29][30][31]35,36,38,39,[41][42][43]46,[48][49][50][51][52][53][54][55][56][57] Appendix 1 summarizes the study characteristics and the investigated variables. Altogether, 33 variables were reported.…”

Section: Resultsmentioning

confidence: 99%

Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Rooij

Rinkel

Dankbaar

et al. 2013

Stroke

166

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Background and Purpose— Established predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage are large amounts of extravasated blood and poor clinical condition on admission. The predictive value of other factors is uncertain. Methods— We searched MEDLINE (1960–2012) for clinical, laboratory, and radiological predictors routinely available within 72 hours after subarachnoid hemorrhage. The studies were categorized according to methodological quality. Crude data and effect estimates (odds ratio [OR], hazard ratios, and risk ratio) with 95% CI were extracted, (re-)calculated and pooled if possible. For every potential predictor we assessed all effect estimates on consistency (point estimates in equal direction) and clinical relevance (size and 95% CI). Results— Fifty-two studies on 33 potential predictors were included. There was strong evidence (≥3 high-quality studies) for a higher risk of delayed cerebral ischemia in smokers (pooled OR, 1.2; 95% CI, 1.1–1.4), and moderate evidence (2 high-quality studies) for an increased risk in patients with hyperglycemia (OR, 3.2; 1.8–5.8 and hazard ratios, 1.7; 1.1–2.5), hydrocephalus (OR, 1.3; 1.1–1.5 and OR, 2.6; 1.2–5.5), history of diabetes mellitus (pooled OR, 6.7; 1.7–26), and early systemic inflammatory response syndrome (pooled OR, 2.1; 1.4–3.3). Evidence was limited for increased risk in women (pooled OR, 1.3; 1.1–1.6) and in patients with history of hypertension (pooled OR, 1.5; 1.3–1.7). The evidence on initial loss of consciousness, history of migraine, previous use of selective serotonin reuptake inhibitors, hypomagnesemia, low hemoglobin, or high blood flow on early transcranial Doppler was also limited. Conclusions— There is strong evidence that smoking is a predictor of delayed cerebral ischemia. For several other potential predictions the evidence is moderate, limited, or inconsistent.

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Section: Resultsmentioning

confidence: 99%

Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Rooij

Rinkel

Dankbaar

et al. 2013

Stroke

166

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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.…”

mentioning

confidence: 73%

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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“…The period of loss of consciousness indicates global ischemia. Hop et al (13) claim that LOC is a strong predictor of the occurrence of DCI.…”

Section: Loss Of Consciousness (Loc)mentioning

confidence: 99%

“…Taking the day of the hemorrhage as day 0, surgical intervals were defined either as immediate (day 0), early (days 1-3), intermediate (days [4][5][6][7][8][9][10][11][12][13][14] or late (days after 14).…”

mentioning

confidence: 99%

Prognostic factors in patients underwent aneurysmal clipping surgery due to spontaneous subarachnoid hemorrhage

Orakdogen

Emon²,

Somay³

et al. 2015

Turkish Neurosurgery

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ABSTRACTaneurysmal SAHs have been investigated in several studies.The aim of the present retrospective study is to examine the various prognostic factors of the clinical outcomes of 104 patients who underwent a neurosurgical clipping of aneurysms due to aneurysmal SAH between 2008 and 2014. █ mATERIAl and mEThODSThe data of 104 patients that had suffered an aneurysmal SAH were analyzed. The patients were recruited between 2008 and 2014 at the Neurosurgery Clinic of Haydarpasa Numune Training and Research Hospital. █ INTRODUCTION D espite the technical and medical advances, aneurysmal subarachnoid hemorrhage (SAH) continue to be a challenging pathology, associated with high rates of morbidity and mortality. The current treatment of the condition involves the early repair of the aneurysm to prevent re-bleeding and associated problems, including cerebral vasospasm, hydrocephalus, electrolyte imbalances, infections and seizures.In this regard, a definition is required of the various prognostic factors of an SAH. The factors affecting the outcomes of AIm: Despite technical and medical advances, aneurysmal subarachnoid hemorrhages (SAH) continue to be a challenging pathology, associated with high rates of morbidity and mortality. In this regard, a definition is required of the various prognostic indicators of an SAH. The aim of the present retrospective study is to examine the various prognostic factors of the clinical outcomes of the patients who underwent a neurosurgical clipping of aneurysms due to aneurysmal SAH. mATERIAl and mEThODS:The data of 104 patients that had suffered an aneurysmal SAH were analyzed. The baseline demographic, clinical and radiological data were all analyzed. The prognostic study was derived from an analysis of these variables. Relationship between prognostic factors and outcome was evaluated by univariate and logistic multivariate regression analysis. RESUlTS:This study has identified unfavorable outcomes on the Glasgow Outcome Scale at discharge after the surgical treatment of aneurysmal SAH associated with increased age, poor World Federation of Neurosurgical Societies (WFNS) grade on admission, higher Fisher's grade on admission computed tomography scan, larger aneurysm, and clinical vasospasm. In a multivariate logistic regression analysis, age, high WFNS grade, positive clinical vasospasm and size of aneurysm were found to be independent risk factors for mortality. The presence of hydrocephalus, number of aneurysms, positive risk factors, and the presence of Doppler vasospasm did not reach statistical significance. CONClUSION:The most important prognostic factors in patients undergoing surgery due to aneurysmal subarachnoid hemorrhage were WFNS grade, age, size of aneurysm and clinical vasospasm.

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Initial Loss of Consciousness and Risk of Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Cited by 130 publications

References 28 publications

Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

Delayed Cerebral Ischemia After Subarachnoid Hemorrhage

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

Prognostic factors in patients underwent aneurysmal clipping surgery due to spontaneous subarachnoid hemorrhage

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