title: Retrospective review of previous minor leak before major subarachnoid hemorrhage diagnosed by MRI as a predictor of occurrence of symptomatic delayed cerebral ischemia.
abstract: OBJECTIVE This study attempted to determine whether a previous minor leak correlated with the occurrence of symptomatic delayed cerebral ischemia (sDCI). METHODS The authors retrospectively evaluated sDCI-related clinical features and findings from MRI, including T1-weighted imaging (T1WI)-FLAIR mismatch at the time of admission, in 151 patients admitted with subarachnoid hemorrhage (SAH) within 48 hours of ictus. RESULTS The overall incidence of sDCI was 23% (35 of 151 patients). In all subjects, multivariate analysis revealed that World Federation of Neurosurgical Societies Grades II-V, age 70 years or older, presence of rebleeding after admission, a previous minor leak before the major SAH attack as diagnosed by T1WI-FLAIR mismatch, acute infarction on diffusion-weighted imaging, and CT SAH score were significantly associated with occurrence of sDCI. In patients with no previous minor leak before major SAH as diagnosed by T1WI-FLAIR mismatch, the incidence of sDCI was only 7% (7 of 97 patients). CONCLUSIONS A previous minor leak before major SAH as diagnosed by T1WI-FLAIR mismatch represents an important sDCI-related factor. When the analysis was restricted to patients with true acute SAH without a previous minor leak diagnosed by T1WI-FLAIR mismatch, the incidence of sDCI was extremely low.
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Shinri
authors.initials: S
authors.lastname: Oda
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Masami
authors.initials: M
authors.lastname: Shimoda
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirayama
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Imai
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Fuminari
authors.initials: F
authors.lastname: Komatsu
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Shigematsu
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Jun
authors.initials: J
authors.lastname: Nishiyama
authors.affiliation: 1Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo; and.
authors.forename: Kazuko
authors.initials: K
authors.lastname: Hotta
authors.affiliation: 2Department of Neurosurgery, Tokai University School of Medicine, Kanagawa, Japan.
authors.forename: Mitsunori
authors.initials: M
authors.lastname: Matsumae
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*
keywords: BHSB = bright hyperintense subarachnoid blood; DWI = diffusion weighted imaging; ICH = intracerebral hemorrhage; SAH = subarachnoid hemorrhage; T1WI = T1-weighted imaging; WFNS = World Federation of Neurosurgical Societies; delayed cerebral ischemia; mRS = modified Rankin Scale; magnetic resonance imaging; minor leak; sDCI = symptomatic delayed cerebral ischemia; subarachnoid hemorrhage; vascular disorders