title: Intracerebral infarcts following clipping of intracranial aneurysms: incidence, clinical correlation and outcome.
abstract: 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.
authors.affiliation: Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Umredkar
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Gupta
authors.forename: Niranjan
authors.initials: N
authors.lastname: Khandelwal
authors.forename: Rajesh
authors.initials: R
authors.lastname: Chhabra
authors.forename: Suresh Narayan
authors.initials: SN
authors.lastname: Mathuriya
authors.forename: Ashish
authors.initials: A
authors.lastname: Pathak
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Tiwari
authors.forename: Kanchan Kumar
authors.initials: KK
authors.lastname: Mukherjee
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mohindra
authors.forename: Navneet
authors.initials: N
authors.lastname: Singla
authors.forename: Praveen
authors.initials: P
authors.lastname: Salunke
mesh_terms: 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