title: Beyond delayed cerebral vasospasm: infarct patterns in patients with subarachnoid hemorrhage.
abstract: OBJECTIVE
  Angiographic vasospasm (CVS) has been accused to be the main cause of delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). However, treatment success including endovascular treatment remains to be improved. We performed a pattern analysis of ischemic lesions in SAH patients in the absence of angiographic cerebral vasospasm to generate further hypotheses concerning etiology and risk factors of DCI apart from vasospastic narrowing.
  
  
  METHODS
  We retrospectively included 309 patients with cerebral infarcts after SAH. Vasospasm was assessed by means of CT or MR angiography and perfusion measurement or digital subtraction angiography. All clinical and radiological data were used to determine the most probable etiology for new infarcts.
  
  
  RESULTS
  Twenty-seven percent of patients showed infarcts without presence of angiographic vasospasm. Seventy-three percent of these "atypical infarcts" were induced by complications of aneurysm therapy, 7 % by hypoxia, 2 % by ICP-related herniation. In 17 %, the etiology remained unclear; however, disturbances of the microcirculation for different reasons were the most likely cause in these patients.
  
  
  CONCLUSIONS
  Beyond CVS and treatment complications, a not insignificant number of SAH patients suffered from infarcts of other etiology probably due to disturbance of the microcirculation. Therapeutic approaches for vasodilation of angiographic vasospasm alone should be reconsidered.
authors.affiliation: Institute of Neuroradiology, Goethe University Hospital, Schleusenweg 2-16, 60528, Frankfurt a. M., Germany. marlies.wagner@kgu.de
authors.forename: M
authors.initials: M
authors.lastname: Wagner
authors.forename: P
authors.initials: P
authors.lastname: Steinbeis
authors.forename: E
authors.initials: E
authors.lastname: Güresir
authors.forename: E
authors.initials: E
authors.lastname: Hattingen
authors.forename: R
authors.initials: R
authors.lastname: du Mesnil de Rochemont
authors.forename: S
authors.initials: S
authors.lastname: Weidauer
authors.forename: J
authors.initials: J
authors.lastname: Berkefeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D002533:Cerebral Angiography / Q000706:statistics & numerical data*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology*; D020301:Vasospasm, Intracranial / Q000175:diagnosis* / Q000453:epidemiology*