Prediction of Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Value of the Hijdra Sum Scoring System

Dupont, Stefan A.; Wijdicks, Eelco F. M.; Manno, Edward M.; Lanzino, Giuseppe; Rabinstein, Alejandro A.

doi:10.1007/s12028-009-9247-3

Cited by 65 publications

(42 citation statements)

References 20 publications

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“…In fact, we did not find an association between blood burden and vasospasm (whether quantified or categorized) in contradistinction to studies in aneurysmal SAH which correlate Hijdra score with risk of vasospasm/DCI. 7,13 This unexpected novel finding echoes that demonstrated in an earlier study showing that those with PM-SAH had a lower risk of vasospasm than a matched cohort with aneurysmal SAH despite similar Hijdra scores. 14 There may be pathophysiologic distinctions between diffuse and PM-SAH that contribute to their differential course.…”

Section: Discussionsupporting

confidence: 74%

“…2 This could be accounted for by the fact that none of even the diffuse nonaneurysmal patients had Hijdra sum scores ≥23, a threshold above which vasospasm was especially frequent in a recent study of aneurysmal SAH. 7 Most prior studies have assumed that the higher risk of vasospasm in those with diffuse bleeding was mediated by differences in blood burden. 4 We are the first to measure Hijdra scores in a large cohort with diffuse versus PM-SAH, confirming that although diffuse bleeding is associated with more intracranial blood, this disparity does not seem to explain the vasospasm risk.…”

Section: Discussionmentioning

confidence: 99%

“…7 Whether blood volume similarly predicts risk of vasospasm in nonaneurysmal SAH is unknown. Greater bleeding may explain why patients with diffuse bleeding have greater neurological morbidity than those with PM-SAH.…”

mentioning

confidence: 99%

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Pattern Not Volume of Bleeding Predicts Angiographic Vasospasm in Nonaneurysmal Subarachnoid Hemorrhage

Raya

Zipfel

Diringer

et al. 2014

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Variables were compared using χ 2 or Mann-Whitney tests. Correlation coefficients were calculated for the association of blood burden and quantitative degree of vasospasm. Odds ratios for rate of outcomes in those with diffuse versus PM-SAH were calculated using logistic regression modeling, after adjustment for covariates, specifically blood burden and established predictors (ie, age and World Federation of Neurosurgical Societies grade).Background and Purpose-Spontaneous idiopathic subarachnoid hemorrhage (SAH) with a perimesencephalic bleeding pattern is usually associated with a benign course, whereas a diffuse bleeding pattern has been associated with a higher risk of vasospasm and disability. We evaluated whether volume of bleeding explains this disparity.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Pattern Not Volume of Bleeding Predicts Angiographic Vasospasm in Nonaneurysmal Subarachnoid Hemorrhage

Raya

Zipfel

Diringer

et al. 2014

Stroke

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“…Even though we cannot formally prove this hypothesis because of the small case number of patients with VSP in our study, this observation is in line with previously published data on the prevalence of VSP in SAH patients. Here the amount of subarachnoid blood is a good predictor of DIND/DCI [1,23,24,25,26]. Because of the assumed time-frame of VSP preceding DIND/DCI, serial TCD may serve as a screening tool in patients with extensive intraventricular hemorrhage that cannot be monitored clinically due to severity of neurological deficit.…”

Section: Discussionmentioning

confidence: 99%

Vasospasm in Intracerebral Hemorrhage with Ventricular Involvement: A Prospective Pilot Transcranial Doppler Sonography Study

et al. 2011

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Background: Cerebral vasospasm (VSP) is a common complication after subarachnoid hemorrhage (SAH), but has rarely been reported after intracerebral hemorrhage (ICH) without subarachnoidal bleeding. The underlying pathophysiological mechanism is mainly mediated by circulating heme products within the cerebrospinal fluid, and thus patients with ICH and ventricular involvement (IVH) may also be in danger of developing VSP. The incidence and role of VSP in IVH, however, have not been systematically studied. Methods: We prospectively enrolled 115 patients with ICH with or without IVH into the study between April 2009 and April 2010. All patients received serial extracranial and transcranial Doppler sonography (TCD) at baseline, on days 3–5 and 7–9 to detect and monitor VSP. In addition, CT scans taken on admission, after 24 h and before discharge were evaluated for the occurrence of delayed cerebral ischemia. Results: Three out of 53 patients (5.7%) with IVH showed a significant elevation of flow velocities over the examined timeframe. One of these patients developed severe VSP resulting in secondary ischemic infarction. None of the ICH patients without IVH showed significantly elevated flow velocities or secondary infarction. Conclusions: Cerebral VSP with secondary infarction may occur in patients with spontaneous IVH, though far less frequently than in SAH; thus, systematic screening of all patients with IVH may not be warranted. However, serial TCD should be considered in patients with secondary clinical worsening or extensive IVH.

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“…For all included patients, we recorded age, gender, clinical status on admission (according to the World Federation of Neurological Surgeons scale 2 ), amount of blood on the admission scan (Hijdra score 8 ), aneurysm location and treatment, and in patients with clinical deterioration, presence of angiographic vasospasm on CTA. The study was approved by our hospital's ethics committee.…”

Section: Designmentioning

confidence: 99%

Diagnostic Threshold Values of Cerebral Perfusion Measured With Computed Tomography for Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

Dankbaar

Rooij

Rijsdijk

et al. 2010

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Background and Purpose-Early diagnosis of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage is critical but difficult. We analyzed diagnostic threshold values of CT perfusion for use in detection of DCI in patients with subarachnoid hemorrhage. Methods-We prospectively enrolled patients with subarachnoid hemorrhage with CT perfusion on admission and at time of clinical deterioration or after 1 week if no deterioration occurred. The gold standard was the clinical diagnosis of DCI based on all clinical, laboratory, and imaging data except CT perfusion. Patients with failed imaging (nϭ6) and other causes of deterioration (nϭ45) were excluded for the current study. We measured CT perfusion values, including cerebral blood volume, blood flow, mean transit time (MTT), and time to peak in predefined regions of interest and then compared absolute perfusion and perfusion asymmetry for patients with and without DCI. Diagnostic threshold values for DCI were evaluated and sensitivity and specificity calculated for optimal thresholds. Results-Of 85 eligible patients with subarachnoid hemorrhage, 50 had DCI; 35 patients with no clinical deterioration comprised the reference group. Cerebral blood flow was significantly lower, MTT higher, and perfusion asymmetry larger in patients with DCI. We found that largest absolute MTT and the MTT difference between hemispheres were good diagnostic tests. Diagnostic threshold values with optimal sensitivity and specificity were an MTT of 5.9 seconds and an MTT difference of 1.1 second. Conclusion-Thresholds

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Prediction of Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Value of the Hijdra Sum Scoring System

Abstract: Hijdra sum score and a history of smoking are the strongest predictors of cerebral vasospasm on angiography. HSS is superior to the MFS as a radiologic grading tool to predict occurrence of angiographic vasospasm after aneurysmal subarachnoid hemorrhage.

Cited by 65 publications

References 20 publications

Pattern Not Volume of Bleeding Predicts Angiographic Vasospasm in Nonaneurysmal Subarachnoid Hemorrhage

Pattern Not Volume of Bleeding Predicts Angiographic Vasospasm in Nonaneurysmal Subarachnoid Hemorrhage

Vasospasm in Intracerebral Hemorrhage with Ventricular Involvement: A Prospective Pilot Transcranial Doppler Sonography Study

Diagnostic Threshold Values of Cerebral Perfusion Measured With Computed Tomography for Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage

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