Intracerebral infarcts following clipping of intracranial aneurysms: incidence, clinical correlation and outcome.
Subarachnoid hemorrhage (SAH) is a significant health care problem. One of the major determinants of outcome following surgery of intracranial aneurysms is development of intracranial infarcts. All patients underwent clipping for aneurysms in one year in the department of neurosurgery, PGIMER, Chandigarh were studied. Data regarding age, sex, date of ictus, date of admission, any co-morbidity, clinical grades at presentation, CT findings, infarcts, intraoperative rupture, and clinical status in the postoperative period were recorded. Outcome at discharge was assessed by Glasgow outcome scale (GOS). First, 174 patients were included in the study. Radiological cerebral infarctions occurred in 69 patients (39%). The most frequent location of infarct was deep perforator infarct followed by ACA territory infarct. 69.58% of patients developed infarct on the same side of aneurysm and 20.28% of patients developed infarct on opposite side, whereas 11% developed bilateral infarcts. Infarcts that occur early after surgery may be related to surgical factors whereas the late infarcts were probably as results of delayed ischemic deficits. Anatomical distribution of infarcts also showed two different patterns, infarcts limited to one vascular territory (more commonly seen in early onset infarcts) or multiple, cortical, bilateral infarcts (more commonly seen in late onset infarct). Patients with poor H&H grade, higher Fisher's grade, intraoperative rupture and prolonged temporary clipping had more chances of developing an intracranial infarct.
Umredkar
Alok
A
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Gupta
Sunil Kumar
SK
Khandelwal
Niranjan
N
Chhabra
Rajesh
R
Mathuriya
Suresh Narayan
SN
Pathak
Ashish
A
Tiwari
Manoj Kumar
MK
Mukherjee
Kanchan Kumar
KK
Mohindra
Sandeep
S
Singla
Navneet
N
Salunke
Praveen
P
D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult