Predictors of Severity of Cerebral Vasospasm caused by Aneurysmal Subarachnoid Hemorrhage

Jabbarli, Ramazan; Gläsker, Sven; Weber, W.; Taschner, Christian; Olschewski, Manfred; Velthoven, Vera Van

doi:10.1016/j.jstrokecerebrovasdis.2013.01.006

Cited by 34 publications

(24 citation statements)

References 59 publications

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“…Several studies suggest that young age is a predictor for symptomatic vasospasm (2,10,15,20), however in our study young age did not predict symptomatic vasospasm. Smith et al (19) concluded that sex, age, Hunt-Hess and Fisher grades are not predictive.…”

Section: Sex and Agecontrasting

confidence: 94%

Predictors of symptomatic vasospasm after subarachnoid hemorrhage: a single center study of 457 consecutive cases

Kozák

Bereczki²,

Szabó³

2015

Turkish Neurosurgery

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400 consecutive patients with SAH in a single neurosurgical center in Eastern Hungary. █ MATERIAL and METHODS Patient PopulationDebrecen is the second largest city in Hungary. It is located in the Eastern part of the country. Data of primary SAH patients admitted or referred to the Department of Neurosurgery at the University of Debrecen between the 1 st of January 1987 and the 31 st of December 2004 were collected prospectively and entered in an anonymized database. Because University of Debrecen is a referring center of the region, patients are registered not only from Debrecen City, but also from several counties of the region with a catchment area of approximately 700 000 inhabitants. SAH was determined by clinical symptoms and neuroimaging findings (CT, angiography). Lumbar █ INTRODUCTION Subarachnoid hemorrhage (SAH) accounts for a minority of all stroke cases but its impact is severe as it strikes at a fairly young age and it is associated with high case fatality and disease burden. After the hemorrhage itself vasospasm is the leading cause of death and disability in SAH patients (14). Angiographic vasospasm develops in up to 70% of the patients, whereas symptomatic vasospasm in 20 to 30% of the cases (7). Several factors were proposed as predictors of vasospasm, such as age, sex, amount of blood on computed tomography (CT) (Fisher grade or other method), admission status etc. Results of these studies are controversial. Furthermore there are significant differences in definitions and methods used in these studies.The aim of the present study was to identify predictors of symptomatic vasospasm in a prospective database of over AIM: We set forth to identify predictors of symptomatic vasospasm in patients with subarachnoid hemorrhage (SAH). MATERIAL and METHODS:We used multivariate logistic regression analysis of the prospective, hospital based, single center register of the Department of Neurosurgery, University of Debrecen, Hungary.Evaluated patients' characteristics were: sex, age, Hunt-Hess grade on admission, location of aneurysm, thickness of blood clot on initial CT scan (Fisher grade), hypertension. RESULTS:Between 1987 and 2004, 567 SAH cases were registered, 457 were included in this study. Symptomatic vasospasm developed in 22.5% of the cases. In univariate analysis, Hunt-Hess grades 2 and 3 and female sex were predictive for symptomatic vasospasm. In multivariate analysis, female sex remained a significant predictor: OR: 1.8 (1.005-3.2). CONCLUSION:Women are at more danger of developing symptomatic vasospasm after subarachnoid hemorrhage.

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Section: Sex and Agecontrasting

confidence: 94%

Predictors of symptomatic vasospasm after subarachnoid hemorrhage: a single center study of 457 consecutive cases

Kozák

Bereczki²,

Szabó³

2015

Turkish Neurosurgery

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“…Hence, our data, although of retrospective nature, explicitly show the strong correlation between the presence of an angiopathy risk factor (FMD) and the predisposition to severe symptomatic vasospasms. To date, age-related changes of the intracranial vasculature have been intensively discussed as important factors influencing the probability and severity of vasospasm [10]. Our data on correlation between FMD and severe vasospasm underlines the crucial role of anatomic and functional condition of vessels for the development and severity of symptomatic vasospasm after SAH.…”

Section: Discussionmentioning

confidence: 53%

“…Therefore, the severity of symptomatic vasospasm was judged upon the need for angioplasty and/or repetitive endovascular treatments. The detailed description of clinical management of SAH patients at our institution has already been reported previously [9,10,11]. …”

Section: Methodsmentioning

confidence: 99%

Early Vasospasm after Aneurysmal Subarachnoid Hemorrhage Predicts the Occurrence and Severity of Symptomatic Vasospasm and Delayed Cerebral Ischemia

Jabbarli¹,

Reinhard²,

Shah³

et al. 2016

Cerebrovasc Dis

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Background: Cerebral vasospasm usually develops several days after subarachnoid hemorrhage (SAH) and is generally acknowledged as a strong outcome predictor. In contrast, much less is known about the nature and eventual consequences of early angiographic vasospasm (EAVS) seen on admission digital subtraction angiography (DSA). Therefore, we aimed at identifying the risk factors and clinical impact of EAVS after SAH. Methods: Five hundred and thirty-one SAH patients with admission DSA performed within 72 h after the bleeding event were selected from a comprehensive database containing all consecutive SAH patients treated at our institution between January 2005 and December 2012. Predictors of EAVS, as well as associations between EAVS and delayed vasospasm-related complications, and unfavorable outcome (defined as modified Rankin scale >3) were evaluated in univariate and multivariate analyses. Results: EAVS was seen on 60 DSAs (11.3%) and was independently correlated with delayed symptomatic vasospasm requiring intra-arterial spasmolysis (OR 5.24, p < 0.0001), angioplasty (OR 2.56, p = 0.015) and repetitive endovascular treatment (OR 4.71, p < 0.0001). EAVS also increased the risk for multiple versus single territorial infarction on the follow-up CT scan(s) (OR 2.04, p = 0.047) and independently predicted unfavorable outcome (OR 2.93, p = 0.008). The presence of radiographic signs suspicious for fibromuscular dysplasia were independently associated with the occurrence of EAVS (OR 2.98, p = 0.026) and the need for repetitive endovascular vasospasm treatment (OR 3.95, p = 0.019). Conclusions: In view of the strong correlation with delayed symptomatic vasospasm and its ischemic complications, EAVS can be considered an alerting signal for severe symptomatic vasospasm. Therefore, more attention should be paid to the presence of EAVS on admission DSA.

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“…63 While younger age and early onset of vasospasm predicts vasospasm severity and risk of delayed cerebral ischemia, gender does not seem to influence either. 64 …”

Section: Sex Differences In Biology/pathophysiologymentioning

confidence: 99%

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease

Madsen

Seigel²,

Mackenzie

et al. 2014

Acad Emerg Med

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Cerebrovascular neurologic emergencies including ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are leading causes of death and disability that are frequently diagnosed and treated in the emergency department (ED). Although sex and gender differences in neurologic emergencies are beginning to become clearer, there are many unanswered questions about how emergency physicians should incorporate sex and gender into their research initiatives, patient evaluations, and overall management plans for these conditions. After evaluating the existing gaps in the literature, a core group of ED researchers developed a draft of future research priorities. Participants in the 2014 Academic Emergency Medicine consensus conference neurologic emergencies working group then discussed and approved the recommended research agenda using a standardized nominal group technique. Recommendations for future research on the role of sex and gender in the diagnosis, treatment, and outcomes pertinent to ED providers are described for each of three diagnoses: stroke, SAH, and migraine. Recommended future research also includes investigation of the biologic and pathophysiologic differences between men and women with neurologic emergencies as they pertain to ED diagnoses and treatments.ACADEMIC EMERGENCY MEDICINE 2014;21:1403-1413 by the Society for Academic Emergency Medicine C erebrovascular neurologic emergencies such as ischemic and hemorrhagic stroke, subarachnoid hemorrhage (SAH), and migraine are among the most lethal and disabling conditions presenting to the emergency department (ED). We have made great strides in understanding and treating these conditions, and our efforts have led to improved outcomes for these patients. Sex-and gender-based distinctions, however, are only recently becoming clearer, and much work is needed to explain the differences observed between men and women. After a focused review of the current literature on preclinical, clinical, and outcomes differences between women and men, and then the consensus process, we propose a research agenda in the areas of stroke, SAH, and headache/migraine. METHODSAfter evaluating the current literature, the authors, all emergency medicine (EM) researchers, proposed an agenda for future research. Consensus was reached using an iterative process through the four-part nominal group technique as already described in the executive summary. 1 A multidisciplinary group of participants (EM, critical care medicine, internal medicine, physical and rehabilitation medicine) prioritized the final iteration of themes/questions using the Poll Everywhere Web-based voting method. Descriptive statistics were calculated to tabulate the final list of questions presented below. The proposed research questions were then discussed and voted on by participants in the Academic Emergency Medicine consensus conference neurologic emergencies working group (see footnote for listing) at the meeting in May 2014. STROKE Epidemiology/OutcomesStroke is the fourth leading ca...

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Predictors of Severity of Cerebral Vasospasm caused by Aneurysmal Subarachnoid Hemorrhage

Cited by 34 publications

References 59 publications

Predictors of symptomatic vasospasm after subarachnoid hemorrhage: a single center study of 457 consecutive cases

Predictors of symptomatic vasospasm after subarachnoid hemorrhage: a single center study of 457 consecutive cases

Early Vasospasm after Aneurysmal Subarachnoid Hemorrhage Predicts the Occurrence and Severity of Symptomatic Vasospasm and Delayed Cerebral Ischemia

Gender Differences in Neurologic Emergencies Part I: A Consensus Summary and Research Agenda on Cerebrovascular Disease

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