Atrophic enlargement of CSF volume after subarachnoid hemorrhage: correlation with neuropsychological outcome.
OBJECTIVE
Ventricular dilation and sulcal enlargement are common sequelae after aSAH. Our aim was to quantify the late ventricular dilation and volumes of the CSF spaces after aSAH and to determine if they correlate with neurologic and cognitive impairments frequently detected in these patients.


METHODS
3D T1-weighted images needed for volumetry were available in 76 patients 1 year after aSAH, along with 75 neuropsychological assessments. Volumes of CSF segments and ICV were quantified by SPM in 76 patients and 30 control subjects to determine CSF/ICV ratios. The mCMI was calculated to roughly evaluate the ventricular dilation. The contributing factors for enlarged ventricles and CSF volumes were reviewed from radiologic, clinical, and neuropsychological perspectives.


RESULTS
The mCMI was higher in patients with aSAH (0.23 +/- 0.06) compared with control subjects (0.20 +/- 0.04; P = .020). In line with these planimetric measurements, the SPM-based CSF/ICV ratios were higher in patients with aSAH (35.58 +/- 7.0) than in control subjects (30.36 +/- 6.25; P = .001). Preoperative hydrocephalus, higher HH and Fisher grades, and focal parenchymal lesions on brain MR imaging, but not the treatment technique, were associated with ventricular enlargement. The clinical outcome and presence of neuropsychological deficits correlated significantly with CSF enlargement.


CONCLUSIONS
Ventricular and sulcal enlargement, together with reduced GM volumes, after aSAH may indicate general atrophy rather than hydrocephalus. Enlarged CSF spaces correlate with cognitive deficits after aSAH. A simple measure, mCMI proved to be a feasible tool to assess the diffuse atrophic brain damage after aSAH.
Bendel
P
P
Department of Clinical Radiology, Kuopio University Hospital and University of Kuopio, Finland. paula.bendel@kuh.fi
Koivisto
T
T
Aikiä
M
M
Niskanen
E
E
Könönen
M
M
Hänninen
T
T
Vanninen
R
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D001284:Atrophy; D002552:Cerebral Ventricles / Q000473:pathology*; D002555:Cerebrospinal Fluid; D002557:Cerebrospinal Fluid Shunts; D003072:Cognition Disorders / Q000473:pathology*; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D013345:Subarachnoid Hemorrhage / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult