Intraventricular extension of an aneurysmal subarachnoid hemorrhage is an independent predictor of a worse functional outcome

Zanaty, Mario; Nakagawa, Daichi; Starke, Robert M.; Leira, Enrique C.; Samaniego, Edgar A; Guerrero, Waldo R; Torner, James C.; Nagahama, Yasunori; Awe, Olatilewa O.; Greenlee, Jeremy D.W.; Hudson, Joseph S.; Allan, Lauren; Elwy, Reem; Chalouhi, Nohra; Jabbour, Pascal; Woodroffe, Royce W.; Piscopo, Anthony; Hasan, David

doi:10.1016/j.clineuro.2018.04.032

Cited by 17 publications

(6 citation statements)

References 23 publications

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“…38 The most prominent factor, however, remains the presence of IVH, which has been identified as an independent predictor of shunt-dependent hydrocephalus, mortality, and functional outcome in aSAH. 39 Besides IVH, many of these factors were not reproduced in our study, and we found no significant association between shunt dependency and the modified Fisher, Hunt and Hess, and WFNS grades. Based on the existing literature, certain scores have been formulated in an attempt to predict shunt-dependent hydrocephalus, including the Barrow Neurological Institute (BNI) score, which evaluates the thickness of the subarachnoid blood clot measured perpendicular to a cistern or fissure; 40 the shunt dependency in aSAH (SDASH) score, which combines the BNI score, the Hunt and Hess grade, and the presence of acute hydrocephalus; 29 the CHESS (Chronic Hydrocephalus Ensuing from SAH Score), which takes into account the Hunt and Hess grade, aneurysm location, presence of acute hy-drocephalus, presence of IVH, and early cerebral infarction; 41 and the Graeb and LeRoux scores, which qualitatively evaluate the amount and location of intraventricular blood.…”

Section: Discussioncontrasting

confidence: 68%

Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures

Daou

Khalsa

Anand

et al. 2021

Journal of Neurosurgery

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OBJECTIVEHydrocephalus and seizures greatly impact outcomes of patients with aneurysmal subarachnoid hemorrhage (aSAH); however, reliable tools to predict these outcomes are lacking. The authors used a volumetric quantitative analysis tool to evaluate the association of total aSAH volume with the outcomes of shunt-dependent hydrocephalus and seizures.METHODSTotal hemorrhage volume following aneurysm rupture was retrospectively analyzed on presentation CT imaging using a custom semiautomated computer program developed in MATLAB that employs intensity-based k-means clustering to automatically separate blood voxels from other tissues. Volume data were added to a prospectively maintained aSAH database. The association of hemorrhage volume with shunted hydrocephalus and seizures was evaluated through logistic regression analysis and the diagnostic accuracy through analysis of the area under the receiver operating characteristic curve (AUC).RESULTSThe study population comprised 288 consecutive patients with aSAH. The mean total hemorrhage volume was 74.9 ml. Thirty-eight patients (13.2%) developed seizures. The mean hemorrhage volume in patients who developed seizures was significantly higher than that in patients with no seizures (mean difference 17.3 ml, p = 0.01). In multivariate analysis, larger hemorrhage volume on initial CT scan and hemorrhage volume > 50 ml (OR 2.81, p = 0.047, 95% CI 1.03–7.80) were predictive of seizures. Forty-eight patients (17%) developed shunt-dependent hydrocephalus. The mean hemorrhage volume in patients who developed shunt-dependent hydrocephalus was significantly higher than that in patients who did not (mean difference 17.2 ml, p = 0.006). Larger hemorrhage volume and hemorrhage volume > 50 ml (OR 2.45, p = 0.03, 95% CI 1.08–5.54) were predictive of shunt-dependent hydrocephalus. Hemorrhage volume had adequate discrimination for the development of seizures (AUC 0.635) and shunted hydrocephalus (AUC 0.629).CONCLUSIONSHemorrhage volume is an independent predictor of seizures and shunt-dependent hydrocephalus in patients with aSAH. Further evaluation of aSAH quantitative volumetric analysis may complement existing scales used in clinical practice and assist in patient prognostication and management.

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Section: Discussioncontrasting

confidence: 68%

Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures

Daou

Khalsa

Anand

et al. 2021

Journal of Neurosurgery

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“…One criticism could be that we did not account for IVH, despite the fact that this has shown prognostic value in several, though not all, studies. 7,15,36,45 Our data did include evaluation of IVH presence; however, with 88.4% and 72.3% of patients with thick, diffuse and other SAH having IVH, respectively, we felt that further analysis would not be meaningful. Another criticism relates to the fact that patients were included if their WFNS grade was between I and IV prior to the procedure and did not worsen to grade V postprocedure, which may have limited the enrollment of very severe patients.…”

Section: Discussionmentioning

confidence: 96%

“…3,4 Previous studies have identified factors contributing to vasospasm-related morbidity and mortality, including increased age, history of hypertension, severity of World Federation of Neurosurgical Societies (WFNS) grade, and, most importantly, the extent of intracranial hemorrhage (subarachnoid and intraventricular). [5][6][7] Correlation between the amount of SAH detected by CT scan at onset and subsequent development of cerebral vasospasm has been well demonstrated. [8][9][10] The Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS)-2 and CONSCIOUS-3 trials were conducted between December 2007 and January 2011 at 102 (CONSCIOUS-2) and 106 (CONSCIOUS-3) centers in 27 countries.…”

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confidence: 95%

Thick and diffuse cisternal clot independently predicts vasospasm-related morbidity and poor outcome after aneurysmal subarachnoid hemorrhage

Aldrich

Higashida

Hmissi

et al. 2021

Journal of Neurosurgery

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OBJECTIVEAneurysmal subarachnoid hemorrhage (aSAH) is associated with significant morbidity and mortality. The presence of thick, diffuse subarachnoid blood may portend a worse clinical course and outcome, independently of other known prognostic factors such as age, aneurysm size, and initial clinical grade.METHODSIn this post hoc analysis, patients with aSAH undergoing surgical clipping (n = 383) or endovascular coiling (n = 189) were pooled from the placebo arms of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS)–2 and CONSCIOUS-3 randomized, double-blind, placebo-controlled phase 3 studies, respectively. Patients without and with thick, diffuse SAH (≥ 4 mm thick and involving ≥ 3 basal cisterns) on admission CT scans were compared. Clot size was centrally adjudicated. All-cause mortality and vasospasm-related morbidity at 6 weeks and Glasgow Outcome Scale–Extended (GOSE) scores at 12 weeks after aSAH were assessed. The effect of the thick and diffuse cisternal aSAH on vasospasm-related morbidity and mortality, and on poor clinical outcome at 12 weeks, was evaluated using logistic regression models.RESULTSOverall, 294 patients (51.4%) had thick and diffuse aSAH. Compared to patients with less hemorrhage burden, these patients were older (median age 55 vs 50 years) and more often had World Federation of Neurosurgical Societies (WFNS) grade III–V SAH at admission (24.1% vs 16.5%). At 6 weeks, all-cause mortality and vasospasm-related morbidity occurred in 36.1% (95% CI 30.6%–41.8%) of patients with thick, diffuse SAH and in 14.7% (95% CI 10.8%–19.5%) of those without thick, diffuse SAH. Individual event rates were 7.5% versus 2.5% for all-cause death, 19.4% versus 6.8% for new cerebral infarct, 28.2% versus 9.4% for delayed ischemic neurological deficit, and 24.8% versus 10.8% for rescue therapy due to cerebral vasospasm, respectively. Poor clinical outcome (GOSE score ≥ 4) was observed in 32.7% (95% CI 27.3%–38.3%) and 16.2% (95% CI 12.1%–21.1%) of patients with and without thick, diffuse SAH, respectively.CONCLUSIONSIn a large, centrally adjudicated population of patients with aSAH, WFNS grade at admission and thick, diffuse SAH independently predicted vasospasm-related morbidity and poor 12-week clinical outcome. Patients with thick, diffuse cisternal SAH may be an important cohort to target in future clinical trials of treatment for vasospasm.

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“…However, our result is not statistically significant. Hence, the effect of IVH drainage on SAH is an intriguing area for further research [19,20].…”

Section: Discussionmentioning

confidence: 99%

Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

Shrestha¹,

Rayamajhi²,

Shrestha³

et al. 2022

Cureus

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Background: Aneurysmal subarachnoid hemorrhage (SAH) has a high morbidity rate. Following SAH, a powerful systemic inflammatory response ensues contributing to delayed neurological deterioration and outcome. The aim of this study is to investigate if peripheral leukocytosis following SAH impacts clinical outcomes.Methods: This is a retrospective, observational, single tertiary center study of patients with SAH who underwent microsurgical clipping between 2017 and 2020. The study's inclusion criteria were aneurysmal SAH on baseline computerized tomography (CT), age above 18 years, and hospital admission within 72 hours of bleeding. Traumatic SAH, arteriovenous malformations, and mycotic aneurysms were all excluded. On admission, leukocyte counts were recorded. Demographic and clinical variables were compared between the two groups (TLC ≤12,000 and >12,000). The impact of peripheral leukocytes on clinical outcomes in terms of the Glasgow Outcome Score (GOS) was analyzed. Mann-Whitney U test for continuous variable and Fisher exact test or chi-square test for categorical variables were used for calculation of P-value. A P-value of 0.05 or less was considered statistically significant.Results: Among 90 patients who underwent clipping of ruptured aneurysms, 40 (44.4%) were anterior communicating artery (ACOMM) aneurysms, and 21 (23.3%) were middle cerebral artery(MCA), and 16 (17.8%) were posterior communicating artery (PCOMM). Clinically 57 patients (63.3%) had a World Federation of Neurosurgical Societies (WFNS) grade 1, 17 patients (18.9%) had a grade 2, four patients (4.4%) had a grade 3, and two patients (2.2%) had a grade 4. On radiological examination, six patients (6.7%) had fisher grade 1, 23 patients (25.6%) had grade 2, 22 patients (24.4%) had grade 3, and 39 (43.4%) had grade 4 SAH distribution. Clinical results were poor in 30 individuals (33.3 %), but good in 60 patients (66.7 %). On admission leukocytosis (>12,000) was seen among 34 (37.8%). Leukocytosis (>12,000) was associated with poor WFNS grade (>2); however, statistical significance was not seen with clinical outcome in terms of GOS.Conclusion: Poor clinical grade of patients following aneurysmal SAH is associated with peripheral leukocytosis; however, peripheral leukocytosis is not associated with poor outcomes.

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Intraventricular extension of an aneurysmal subarachnoid hemorrhage is an independent predictor of a worse functional outcome

Cited by 17 publications

References 23 publications

Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures

Volumetric quantification of aneurysmal subarachnoid hemorrhage independently predicts hydrocephalus and seizures

Thick and diffuse cisternal clot independently predicts vasospasm-related morbidity and poor outcome after aneurysmal subarachnoid hemorrhage

Peripheral Leukocytosis and Clinical Outcomes After Aneurysmal Subarachnoid Hemorrhage

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