title: Impact of global cerebral atrophy on clinical outcome after subarachnoid hemorrhage.
abstract: OBJECTIVE
  Atrophy in specific brain areas correlates with poor neuropsychological outcome after subarachnoid hemorrhage (SAH). Few studies have compared global atrophy in SAH with outcome. The authors examined the relationship between global brain atrophy, clinical factors, and outcome after SAH.
  
  
  METHODS
  This study was a post hoc exploratory analysis of the Clazosentan to Overcome Neurological Ischemia and Infarction Occurring After Subarachnoid Hemorrhage (CONSCIOUS-1) trial, a randomized, double-blind, placebo-controlled trial of 413 patients with aneurysmal SAH. Patients with infarctions or areas of encephalomalacia on CT, and those with large clip/coil artifacts, were excluded. The 97 remaining patients underwent CT at baseline and 6 weeks, which was analyzed using voxel-based volumetric measurements. The percentage difference in volume between time points was compared against clinical variables. The relationship with clinical outcome was modeled using univariate and multivariate analysis.
  
  
  RESULTS
  Older age, male sex, and systemic inflammatory response syndrome (SIRS) during intensive care stay were significantly associated with brain atrophy. Greater brain atrophy was significantly associated with poor outcome on the modified Rankin scale (mRS), severity of deficits on the National Institutes of Health Stroke Scale (NIHSS), worse executive functioning, and lower EuroQol Group-5D (EQ-5D) score. Adjusted for confounders, brain atrophy was not significantly associated with Mini-Mental State Examination and Functional Status Examination scores. Brain atrophy was not associated with angiographic vasospasm or delayed ischemic neurological deficit.
  
  
  CONCLUSIONS
  Worse mRS score, NIHSS score, executive functioning, and EQ-5D scores were associated with greater brain atrophy and older age, male sex, and SIRS burden. These data suggest outcome is associated with factors that cause global brain injury independent of focal brain injury.
authors.affiliation: Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Alan K H
authors.initials: AK
authors.lastname: Tam
authors.forename: Anish
authors.initials: A
authors.lastname: Kapadia
authors.forename: Don
authors.initials: D
authors.lastname: Ilodigwe
authors.forename: Zeyu
authors.initials: Z
authors.lastname: Li
authors.forename: Tom A
authors.initials: TA
authors.lastname: Schweizer
authors.forename: R Loch
authors.initials: RL
authors.lastname: Macdonald
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D002544:Cerebral Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D004146:Dioxanes / Q000627:therapeutic use*; D004311:Double-Blind Method; D004621:Embolization, Therapeutic; D004660:Encephalitis / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D065130:Endothelin A Receptor Antagonists; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D011725:Pyridines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D020127:Recovery of Function; D012307:Risk Factors; D017678:Sex Distribution; D013345:Subarachnoid Hemorrhage / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy*; D013449:Sulfonamides / Q000627:therapeutic use*; D013777:Tetrazoles / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D004146:Dioxanes; D065130:Endothelin A Receptor Antagonists; D011725:Pyridines; D011743:Pyrimidines; D013449:Sulfonamides; D013777:Tetrazoles; C109641:clazosentan