title: Early cerebral circulatory disturbance in patients suffering subarachnoid hemorrhage prior to the delayed cerebral vasospasm stage: xenon computed tomography and perfusion computed tomography study.
abstract: Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR], moderate disability [MD], severe disability [SD], vegetative state [VS], or death [D]). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.
authors: Department of Critical Care Center, Toho University Medical Center Omori Hospital, Tokyo, Japan. mhonda@toho-u.ac.jp
authors: Mitsuru
authors: M
authors: Honda
authors: Shigeru
authors: S
authors: Sase
authors: Kyosuke
authors: K
authors: Yokota
authors: Ryo
authors: R
authors: Ichibayashi
authors: Katsunori
authors: K
authors: Yoshihara
authors: Yoshihito
authors: Y
authors: Sakata
authors: Hiroyuki
authors: H
authors: Masuda
authors: Hiroyuki
authors: H
authors: Uekusa
authors: Yoshikatsu
authors: Y
authors: Seiki
authors: Taichi
authors: T
authors: Kishi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002560:Cerebrovascular Circulation / Q000502:physiology*; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000592:standards; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D014980:Xenon Radioisotopes
chemical_list: D014980:Xenon Radioisotopes