title: Predictors of severity of cerebral vasospasm caused by aneurysmal subarachnoid hemorrhage.
abstract: BACKGROUND
  Cerebral vasospasm is one of the leading causes of poor outcome after aneurysmal subarachnoid hemorrhage. The risk factors for the development of vasospasm have been evaluated in many clinical studies. However, it remains unclear if vasospasm severity can be predicted. The purpose of this study was to determine if different demographic and clinical factors that appear to be predictors of vasospasm can also prognosticate the severity of cerebral vasospasm.
  
  
  METHODS
  We retrospectively analyzed consecutive patients with subarachnoid hemorrhage who underwent endovascular vasospasm treatment in a single center. In order to define predictors of vasospasm severity, we studied the demographic and clinical characteristics of these patients. Vasospasm severity was defined by cerebral angiography, transcranial Doppler ultrasound, and therapeutic response on endovascular treatment. Statistical analyses were performed to determine significant predictors.
  
  
  RESULTS
  A total of 70 patients with vasospasm were included. Early onset of mean flow velocities>160 cm/second on transcranial Doppler ultrasound correlated with severity of angiographic vasospasm (P=.0469) and resistance against intra-arterial papaverine (P=.0277). Younger age (<51 years of age) was significantly associated with severity of vasospasm regarding extension on angiography (P=.0422), the need for repetitive endovascular treatment (P=.0084), persistence of transcranial Doppler ultrasound vasospasm after endovascular treatment (P=.0004), and resistance against intra-arterial papaverine (P=.0341).
  
  
  CONCLUSIONS
  Younger age and early onset of vasospasm on transcranial Doppler ultrasound are important predictors for vasospasm severity. We recommend early and aggressive therapy in this subgroup.
authors: Department of Neurosurgery, University Hospital of Freiburg, Germany.
authors: Ramazan
authors: R
authors: Jabbarli
authors: Sven
authors: S
authors: Gläsker
authors: Johannes
authors: J
authors: Weber
authors: Christian
authors: C
authors: Taschner
authors: Manfred
authors: M
authors: Olschewski
authors: Vera
authors: V
authors: Van Velthoven
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology*; D055815:Young Adult
keywords: Angioplasty; cerebral vasospasm; intra-arterial papaverine; predictor; severity; subarachnoid hemorrhage; transcranial Doppler