Predictors and impact of early cerebral infarction after aneurysmal subarachnoid hemorrhage
| Autor: | Vera Van Velthoven, Ramazan Jabbarli, Wolf-Dirk Niesen, Matthias Reinhard, Mukesch Shah, Roland Roelz, Beate Hippchen, Klaus Kaier, Christian Taschner |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Subarachnoid hemorrhage Medizin Infarction Young Adult Internal medicine Humans Medicine Hospital Mortality cardiovascular diseases Aged Intracranial pressure Aged 80 and over business.industry Cerebral infarction Clinical course Vasospasm Cerebral Infarction Odds ratio Middle Aged Subarachnoid Hemorrhage Prognosis medicine.disease Neurology cardiovascular system Cardiology Female Neurology (clinical) Tomography X-Ray Computed business Complication Follow-Up Studies |
| Zdroj: | European Journal of Neurology. 22:941-947 |
| ISSN: | 1351-5101 |
| DOI: | 10.1111/ene.12686 |
| Popis: | Cerebral infarction is a frequent and serious complication of aneurysmal subarachnoid hemorrhage (SAH). This study aimed to identify independent predictors of the timing of cerebral infarction and clarify its impact on disease course and patients' outcome.All consecutive patients with SAH admitted to our institution from January 2005 to December 2012 were analyzed. Serial computed tomography (CT) scans were evaluated for cerebral infarctions. Demographic, clinical, laboratory and radiological data of patients during hospitalization as well as clinical follow-ups 6 months after SAH were recorded.Of the 632 analyzed patients, 320 (51%) developed cerebral infarction on CT scans. 136 patients (21.5%) with early cerebral infarction (occurring within 3 days after SAH) had a significantly higher risk of unfavorable outcome than patients with late infarction [odds ratio (OR) 2.94; P = 0.008], a higher in-hospital mortality (OR 3.14; P = 0.0002) and poorer clinical outcome after 6 months (OR 0.54; P0.0001). The rates of decompressive craniectomy (OR 1.96, P = 0.0265), tracheostomy (OR 1.87, P = 0.0446), the duration of intensive care unit stay and mechanical ventilation were significantly higher in patients with early infarction. In multivariate analysis, Hunt and Hess grades 4 and 5 (OR 2.06, P = 0.008), Fisher grades 3 and 4 (OR 3.99, P = 0.014), sustained elevations of intracranial pressure20 mmHg (OR 5.95, P0.0001) and early vasospasm on diagnostic angiograms (OR 3.01, P = 0.008) were predictors of early cerebral infarction.Early cerebral infarction after SAH is associated with severe clinical course and unfavorable outcome and can be reliably predicted by poor initial clinical condition, thick subarachnoid clot, early angiographic vasospasm and sustained elevations of intracranial pressure. |
| Databáze: | OpenAIRE |
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