title: Acute physiological derangement is associated with early radiographic cerebral infarction after subarachnoid haemorrhage.
abstract: BACKGROUND
  Cerebral infarction after aneurysmal subarachnoid haemorrhage (SAH) is presumed to be due to cerebral vasospasm, defined as arterial lumen narrowing from days 3 to 14.
  
  
  METHODS
  We reviewed the computed tomography scans of 103 patients with aneurysmal SAH for radiographic cerebral infarction and controlled for other predictors of outcome. A blinded neuroradiologist reviewed the angiograms. Cerebral infarction from vasospasm was judged to be unlikely if it was visible on computed tomography within 2 calendar days of SAH or if angiography showed no vasospasm in a referable vessel, or both.
  
  
  RESULTS
  Cerebral infarction occurred in 29 (28%) of 103 patients with SAH. 18 patients had cerebral infarction that was unlikely to be due to vasospasm because it was visible on computed tomography by day 2 (6 (33%)) or because angiography showed no vasospasm in a referable artery (7 (39%)), or both (5 (28%)). In a multivariate model, cerebral infarction was significantly related to World Federation of Neurologic Surgeons grade (odds ratio (OR) 1.5/grade, 95% confidence interval (CI) 1.1 to 2.01, p = 0.006) and SAH-Physiologic Derangement Score (PDS) >2 (OR 3.7, 95% CI 1.4 to 9.8, p = 0.01) on admission. Global cerebral oedema (OR 4.3, 95% CI 1.5 to 12.5, p = 0.007) predicted cerebral infarction. Patients with cerebral infarction detectable by day 2 had a higher SAH-PDS than patients with later cerebral infarction (p = 0.025).
  
  
  CONCLUSIONS
  Many cerebral infarctions after SAH are unlikely to be caused by vasospasm because they occur too soon after SAH or because angiography shows no vasospasm in a referable artery, or both. Physiological derangement and cerebral oedema may be worthwhile targets for intervention to decrease the occurrence and clinical impact of cerebral infarction after SAH.
authors.affiliation: Department of Neurology, Northwestern University, 710 N Lake Shore Drive, Chicago, IL 60611, USA. a-naidech@northwestern.edu
authors.forename: A M
authors.initials: AM
authors.lastname: Naidech
authors.forename: J
authors.initials: J
authors.lastname: Drescher
authors.forename: P
authors.initials: P
authors.lastname: Tamul
authors.forename: A
authors.initials: A
authors.lastname: Shaibani
authors.forename: H H
authors.initials: HH
authors.lastname: Batjer
authors.forename: M J
authors.initials: MJ
authors.lastname: Alberts
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D014057:Tomography, X-Ray Computed; D020301:Vasospasm, Intracranial / Q000150:complications / Q000209:etiology