title: Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome.
abstract: BACKGROUND
  Impaired cerebral autoregulation (CA) is increasingly recognized to contribute to sequelae after aneurysmal subarachnoid hemorrhage (SAH). The current study characterizes the course of the dynamic autoregulation index (ARI) during the first 8 days after SAH and its coherence with angiographic vasospasm (VS) and clinical outcome.
  
  
  METHODS
  Fifty-one patients with SAH were prospectively included within 48 h after the ictus. The ARI was determined daily for each hemisphere with the thigh cuff test. The degree of cerebral VS was evaluated based on a baseline digital subtraction angiography (DSA) after the ictus and a follow-up DSA on day 8. The clinical outcome was determined by the Modified Rankin Scale (mRS), the Glasgow Outcome Scale Extended (GOSE), and the National Institute of Health Stroke Scale (NIHSS) at discharge from the intensive care unit.
  
  
  RESULTS
  Impaired CA significantly correlated with unfavorable clinical outcome scores (mRS, p = 0.0021; GOSE, p = 0.0027; NIHSS, p = 0.0091). ARI-values of patients with a favorable clinical outcome (mRS 0-3) showed a significant improvement during the first 8 days (+0.1964/day; p = 0.0148) compared to a significant decrease of ARI-values in patients with an unfavorable clinical outcome (-0.2976/day; p = 0.0182). The degree of CA impairment significantly correlated with the severity of VS in the middle cerebral artery (p = 0.0184).
  
  
  CONCLUSIONS
  Early deterioration of CA significantly correlates with unfavorable clinical outcome and severity of angiographic vasospasm. Dynamic CA measurements might represent an important tool in stratifying therapy guidelines in patients after SAH.
authors.affiliation: Department of Neurosurgery, Knappschafts-Krankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany. johann.fontana@kk-bochum.de.
authors.forename: Johann
authors.initials: J
authors.lastname: Fontana
authors.affiliation: Department of Neurosurgery, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Moratin
authors.affiliation: Department of Neurosurgery, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
authors.forename: Gregory
authors.initials: G
authors.lastname: Ehrlich
authors.affiliation: Department of Neuroradiology, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Scharf
authors.affiliation: Department of Medical Statistics, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.
authors.forename: Christel
authors.initials: C
authors.lastname: Weiß
authors.affiliation: Department of Neurosurgery, Knappschafts-Krankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Schmieder
authors.affiliation: Department of Neurosurgery, Knappschafts-Krankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany. martin.barth@kk-bochum.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Barth
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging*; D017063:Outcome Assessment, Health Care; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging*
keywords: Cerebral autoregulation; Cerebral vasospasm; Dynamic autoregulation index; Subarachnoid hemorrhage