Subarachnoid Clot Volume Correlates With Age, Neurological Grade, and Blood Pressure

Rosen, David S.; Amidei, Chris; Tolentino, Jocelyn; Reilly, Christopher; Macdonald, R. Loch

doi:10.1227/01.neu.0000249271.56816.03

Cited by 33 publications

(14 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, those trials had some limitations in the following respects. First, between total ICH volume and SAH volume, they did not show which one was really associated with development of cerebral vasospasm 5)14). Second, some studies only included patients with Fisher grade 3 4)11).…”

Section: Discussionmentioning

confidence: 99%

“…Poor clinical grade (related to more severe hemorrhage), age and cigarette smoking have been reported as independent risk factors for symptomatic vasospasm 5)6)8)9)13)14)22)…”

Section: Discussionmentioning

confidence: 99%

“…Some quantitative trials have been reported in the literature 1)4)5)11)14). However, those trials had some limitations in the following respects.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Relationship Between Subarachnoid Hemorrhage Volume and Development of Cerebral Vasospasm

Jung

Lee

Yim

2012

J Cerebrovasc Endovasc Neurosurg

View full text Add to dashboard Cite

ObjectiveThe objective of this study is to verify the relationship between subarachnoid hemorrhage (SAH) volume (not Fisher grade) and development of cerebral vasospasm prospectively.MethodsPatients who visited our hospital with a diffuse or localized thick subarachnoid blood clot seen on computed tomography (CT), taken within 48 hours after SAH and the aneurysm was confirmed by CT Angiogram (CTA) from March 2010 to July 2011 were enrolled in this study. CTA was checked at least twice after admission. Angiographic vasospasm (AVS) on CTA was defined as irregularity or narrowing of intracranial vessels on follow up CTA compared with initial CTA. Total intracranial hemorrhage (ICH) volume (subdural, SAH, intracerebral and intraventricular) was calculated and SAH volume (all supratentorial and infratentorial cisterns) was also calculated using the MIPAV software package.ResultsA total of 55 patients were included in our study. Thirty six patients did not show AVS on CTA or clinical deterioration (non vasospasm group: NVS). AVS without ischemic neurologic symptoms was observed in four patients and development of symptomatic vasospasm (SVS), defined as AVS with ischemic symptoms, was observed in 15 patients. SAH volume in SVS patients was statistically larger than that in NVS patients (p < 0.05). Total ICH volume in SVS patients was larger than that in NVS patients. However, the difference was not statistically significant.ConclusionResults of this study indicate an association of development of vasospasm with the SAH volume, not intracranial hemorrhage.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Poor clinical grade (related to more severe hemorrhage), age and cigarette smoking have been reported as independent risk factors for symptomatic vasospasm 5)6)8)9)13)14)22)…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Relationship Between Subarachnoid Hemorrhage Volume and Development of Cerebral Vasospasm

Jung

Lee

Yim

2012

J Cerebrovasc Endovasc Neurosurg

View full text Add to dashboard Cite

show abstract

“…Although age is well described as an independent predictor of outcome and advanced age has been consistently associated with lower incidence of angiographic vasospasm and DCI, 16,[30][31][32][33] aging is inversely related to favorable outcomes. 3 Older age is associated with larger subarachnoid clot volume, 34 and elderly patients (>60 years) have significant increased risk of poor outcome 3 because of higher rates of medical complications, 32,35 the main reason age was not included in our grading scale.…”

Section: 11mentioning

confidence: 99%

The VASOGRADE

Manoel¹,

Jaja

Germans³

et al. 2015

Stroke

Self Cite

104

View full text Add to dashboard Cite

Background and Purpose— Patients are classically at risk of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage. We validated a grading scale—the VASOGRADE—for prediction of DCI. Methods— We used data of 3 phase II randomized clinical trials and a single hospital series to assess the relationship between the VASOGRADE and DCI. The VASOGRADE derived from previously published risk charts and consists of 3 categories: VASOGRADE-Green (modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale [WFNS] 1 or 2); VASOGRADE-Yellow (modified Fisher 3 or 4 and WFNS 1–3); and VASOGRADE-Red (WFNS 4 or 5, irrespective of modified Fisher grade). The relation between the VASOGRADE and DCI was assessed by logistic regression models. The predictive accuracy of the VASOGRADE was assessed by receiver operating characteristics curve and calibration plots. Results— In a cohort of 746 patients, the VASOGRADE significantly predicted DCI ( P <0.001). The VASOGRADE-Yellow had a tendency for increased risk for DCI (odds ratio [OR], 1.31; 95% CI, 0.77–2.23) when compared with VASOGRADE-Green; those with VASOGRADE-Red had a 3-fold higher risk of DCI (OR, 3.19; 95% CI, 2.07–4.50). Studies were not a significant confounding factor between the VASOGRADE and DCI. The VASOGRADE had an adequate discrimination for prediction of DCI (area under the receiver operating characteristics curve=0.63) and good calibration. Conclusions— The VASOGRADE results validated previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients, which allows DCI risk stratification on presentation after subarachnoid hemorrhage. It could help to select patients at high risk of DCI, as well as standardize treatment protocols and research studies.

show abstract

“…In intact cerebral autoregulation, arterial smooth muscle cells will react to intravascular pressure or changes in brain metabolism to maintain Rosen et al found that the volume of the subarachnoid clot is typically larger in elderly patients, which may be explained by brain atrophy with larger cistern spaces, and in hypertensive patients and patients presenting with higher WFNS grade (37). A larger subarachnoid clot may explain poor outcomes in these groups of patients.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Pre- and Post-Operative Cerebral Perfusion in Anterior Circulation Intracranial Aneurysm Clipping Patients at Hospital Sungai Buloh Using CT Perfusion Scan and Correlations to Fisher, Navarro and WFNS Scores

Ghani

Nayan

Kandasamy

et al. 2017

MJMS

View full text Add to dashboard Cite

Background: Intracranial aneurysms may rupture and are typically associated with high morbidity and mortality, commonly due to vasospasm after rupture. Once the aneurysm ruptures, the patient's cerebral blood flow may be disturbed during the acute phase, affecting cerebral circulation and thus cerebral perfusion prior to the onset of vasospasm. Fisher and Navarro scores are used to predict vasospasm, while World Federation of Neurosurgical Societies (WFNS) scores are used to predict patient outcomes. Several score modifications are available to obtain higher sensitivity and specificity for the prediction of vasospasm development, but these scores are still unsuccessful. Alternatively, cerebral CT perfusion scan (CTP) is a non-invasive method for measuring cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) in regions of interests (ROI) to obtain the cerebral perfusion status as well as detecting vasospasm.Methods: A total of 30 patients' data with clipped anterior circulation intracranial aneurysms admitted to the hospital between 1 January 2013 and 30 June 2014, were collected from the hospital's electronic database. The data collected included patients' admissions demographic profiles, Fisher, Navarro and WFNS scores; and their immediate pre-and postoperative CTP parameters.Results: This study found a significant increase in post-operative MTT (pre-and postoperative MTT) were 9.75 (SD = 1.31) and 10.44 (SD = 1.56) respectively, (P < 0.001)) as well as a significant reduction in post-operative CBF (pre-and post-operative mean CBF were 195.29 (SD = 24.92) and 179.49 (SD = 31.17) respectively (P < 0.001)). There were no significant differences in CBV. There were no significant correlations between the pre-and post-operative CTP parameters and Fisher, Navarro or WFNS scores.Conclusion: Despite the interest in using Fisher, Navarro and WFNS scores to predict vasospasm and patient outcomes for ruptured intracranial aneurysms, this study found no significant correlations between these scores in either pre-or post-operative CTP parameters. Assessment of Pre 48These results explain the disagreement in the field regarding the multiple proposed grading systems for vasospasm prediction. CTP measures more than just anatomical structures; therefore, it is more sensitive towards minor changes in cerebral perfusion that would not be detected by WFNS, Fisher or Navarro scores.

show abstract

Subarachnoid Clot Volume Correlates With Age, Neurological Grade, and Blood Pressure

Abstract: SAH volume is correlated with clinical characteristics, including age, history of hypertension, admission systolic blood pressure, and WFNS grade. Anatomic aneurysm characteristics such as size and location do not reliably predict clot volume.

Cited by 33 publications

References 27 publications

The Relationship Between Subarachnoid Hemorrhage Volume and Development of Cerebral Vasospasm

The Relationship Between Subarachnoid Hemorrhage Volume and Development of Cerebral Vasospasm

The VASOGRADE

Assessment of Pre- and Post-Operative Cerebral Perfusion in Anterior Circulation Intracranial Aneurysm Clipping Patients at Hospital Sungai Buloh Using CT Perfusion Scan and Correlations to Fisher, Navarro and WFNS Scores

Contact Info

Product

Resources

About