title: Reduced ipsilateral hemispheric cerebral blood flow at admission is predictive of vasospasm with infarction after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  Cerebral vasospasm (CV) with infarction causes a significant degree of morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). We sought to determine if reduced cerebral blood flow (CBF) on Xenon CT within 48 h of the ictus was predictive of developing CV with infarction.
  
  
  METHODS
  This is a prospective study from 1999 to 2006 of 97 patients with aSAH who underwent Xenon CT within 48 h of their bleed. Demographic, clinical, radiographic, and angiographic parameters were investigated as potential risk factors for the development of CV with infarction. A binary logistic regression analysis was performed to determine the independent predictors of this endpoint.
  
  
  RESULTS
  A total of 97 patients with a mean age of 54 +/- 12 years were studied. A total of 78 (80.4%) patients presented with a Fisher grade of 3 and 51 (52.6%) patients with a Hunt Hess score >or=3. CV with infarction was found in 33 (34%) patients. In univariate modeling, younger patients with a Fisher scale of 3 or a reduced ipsilateral mean hemispheric CBF had an association with developing CV with infarction. In binary logistic regression modeling, patients with lower initial hemispheric CBF's were at a significant risk of CV with infarction in the ipsilateral hemisphere.
  
  
  CONCLUSIONS
  Lower initial CBF at presentation is a risk factor for developing CV with infarction. These findings may help in early prediction of this entity and may have therapeutic implications in the future.
authors.affiliation: Department of Neurology, Division of Cerebrovascular Diseases, Michigan State University, East Lansing, MI, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Crago
authors.forename: Matthew
authors.initials: M
authors.lastname: Gallek
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.forename: Leslie
authors.initials: L
authors.lastname: Hoffman
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.forename: Howard
authors.initials: H
authors.lastname: Yonas
mesh_terms: D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology; D014978:Xenon
chemical_list: D014978:Xenon