Clinical, transcranial Doppler ultrasound, radiological features and, prognostic significance of delayed cerebral ischemia.
OBJECTIVE
We aimed to investigate the profiles and prognostic values of delayed cerebral ischemia (DCI) and delayed cerebral infarction.


METHODS
IMASH (Intravenous Magnesium Sulphate for Aneurysmal Subarachnoid Hemorrhage) was registered at http://www.strokecenter.org/trials , and http://www.ClinicalTrials.gov (NCT00124150). Data of 327 patients were retrieved for logistic regression analyses.


RESULTS
Seventy-one (22%) patients developed DCI, and 35 (11%) patients developed delayed cerebral infarction. Only 18 (25%) patients with DCI and 7/35 (20%) patients with delayed cerebral infarction had mean middle cerebral artery velocities (transcranial Doppler ultrasound) over 120 cm/s. Regarding the prognostic significance of the components of DCI, delayed cerebral infarction predicted unfavorable outcome in terms of Extended Glasgow Outcome Scale (OR 3.1, 95% [CI] 1.3-7.8), poor outcome in terms of modified Rankin Scale (odds ratio [OR] 3.0, 95% confidence interval CI 1.2-7.7), and dependent activity of daily living in terms of Barthel Index (OR 3.6, 95% CI 1.4-9.2) at 6 months, after adjustments for other prognostic factors. On the other hand, clinical deterioration predicted inpatient mortality (OR 8.8, 95% CI 1.6-48.8) after adjustments for other prognostic factors.


CONCLUSIONS
Delayed cerebral ischemia and delayed cerebral infarction carried different prognostic values in aneurysmal subarachnoid hemorrhage.
Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China. georgewong@surgery.cuhk.edu.hk
George Kwok Chu
GK
Wong
Wai Sang
WS
Poon
D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008278:Magnesium Sulfate / Q000627:therapeutic use; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000188:drug therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
D008278:Magnesium Sulfate