title: Brain injury visible on early MRI after subarachnoid hemorrhage might predict neurological impairment and functional outcome.
abstract: BACKGROUND
  In subarachnoid hemorrhage (SAH), brain injury visible within 48 h of onset may impact on admission neurological disability and 3-month functional outcome. With volumetric MRI, we measured the volume of brain injury visible after SAH, and assessed the association with admission clinical grade and 3-month functional outcome.
  
  
  METHODS
  Retrospective cohort study conducted in the Neurocritical Care Division, Columbia University Medical Center, New York, USA. On brain MRI acquired within 48 h of SAH-onset and before aneurysm-securing (n = 27), two blinded readers measured DWI and FLAIR-lesion volumes using semi-automated, computer segmentation software.
  
  
  RESULTS
  Compared to post-resuscitation Hunt-Hess grade 1-3 (70 %), high-grade patients (30 %) had higher lesion volumes on DWI (34 ml [IQR: 0-64] vs. 2 ml [IQR: 0.5-7], P = 0.02) and on FLAIR (81 ml [IQR: 24-127] vs. 3 ml [IQR: 0-27], P = 0.02). On DWI, each 10 ml increase in lesion volume was associated with a 101 %-increase in the odds of presenting with 1 grade more in the Hunt-Hess scale (aOR 2.01, 95 % CI 1.10-3.68, P = 0.02), but was not significantly associated with 3-month outcome. On FLAIR, each 10 ml increase in lesion volume was associated with 34 % higher odds of a 1-point increase on the Hunt-Hess scale (aOR 1.34, 95 % CI 1.06-1.68, P = 0.01) and 139 % higher odds of a 1-point increase on the 3-month mRS (aOR 2.39, 95 % CI 1.13-5.07, P = 0.02).
  
  
  CONCLUSIONS
  The volume of brain injury visible on DWI and FLAIR within 48 h after SAH is proportional to neurological impairment on admission. Moreover, FLAIR-imaging implicates chronic brain injury-predating SAH-as potentially relevant cause of poor functional outcome.
authors.affiliation: Division of Neurocritical Care, Department of Neurology and Neurosurgery, Columbia University, New York, NY, USA, gianmarcodemarchis@me.com.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: De Marchis
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Filippi
authors.forename: Xiaotao
authors.initials: X
authors.lastname: Guo
authors.forename: Deborah
authors.initials: D
authors.lastname: Pugin
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Gaffney
authors.forename: Neha S
authors.initials: NS
authors.lastname: Dangayach
authors.forename: Sureerat
authors.initials: S
authors.lastname: Suwatcharangkoon
authors.forename: M Cristina
authors.initials: MC
authors.lastname: Falo
authors.forename: J Michael
authors.initials: JM
authors.lastname: Schmidt
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.forename: Binsheng
authors.initials: B
authors.lastname: Zhao
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
mesh_terms: D000368:Aged; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D013997:Time Factors