Reduced ipsilateral hemispheric cerebral blood flow at admission is predictive of vasospasm with infarction after aneurysmal subarachnoid hemorrhage.
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.
Gupta
Rishi
R
Department of Neurology, Division of Cerebrovascular Diseases, Michigan State University, East Lansing, MI, USA.
Crago
Elizabeth A
EA
Gallek
Matthew
M
Horowitz
Michael
M
Hoffman
Leslie
L
Jovin
Tudor
T
Yonas
Howard
H
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
D014978:Xenon