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Comparison of cerebral perfusion in perimesencephalic subarachnoid hemorrhage and aneurysmal subarachnoid hemorrhage

  • Diagnostic Neuroradiology
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Abstract

Purpose

Perimesencephalic hemorrhage (PMH) is a benign subtype of nonaneurysmal subarachnoid hemorrhage (SAH). We aimed to investigate if cerebral perfusion in PMH is less affected than in aneurysmal SAH (aSAH).

Methods

From a prospective cohort of 80 patients with spontaneous SAH, we included PMH patients (n = 15) and selected aSAH patients (n = 39) with similar clinical grade at admission (World Federation of Neurosurgeons Scale-WFNS I/II). Computed tomography (CT) perfusion was performed at < 72 h and/or at 8–10 days. Cerebral perfusion parameter values were compared between groups with nonparametric tests. Subgroup analyses compared PMH and aSAH patients stratified according to aneurysmal location (anterior or posterior circulation) and blood burden (Fisher grade).

Results

At < 72 h, no significant differences in perfusion parameters were found between PMH and aSAH patients. At 8–10 days, PMH patients had lower MTT than aSAH patients, and a trend for higher CBF. PMH patients had higher CBF and CBV at < 72 h when compared to posterior circulation aSAH patients. When compared to aSAH patients with similar blood burden, PMH patients had higher CBF and lower MTT at < 72 h, and lower MTT at 8–10 days.

Conclusion

PMH patients had better cerebral perfusion compared to patients with aSAH, particularly during the vasospasm time window. After stratifying for the amount of blood, PMH patients also had better cerebral perfusion in the first 72 h after SAH. These results are in line with the better clinical presentation and prognosis of PMH, and possibly with a different etiology.

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Authors and Affiliations

  1. Neuroradiology Department, Hospital São José, Centro Hospitalar Lisboa Central, NOVA Medical School, Lisbon, Portugal

    Isabel Fragata

  2. Department of Neuroradiology, Department of Pediatric Radiology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

    Nuno Canto-Moreira

  3. Department of Neurosciences and Mental Health, Neurology, Faculty of Medicine, Hospital de Santa Maria, CHLN, University of Lisbon, Lisbon, Portugal

    Patrícia Canhão

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  1. Isabel Fragata
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  3. Patrícia Canhão
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Correspondence to Isabel Fragata.

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Funding

IF was funded by a scholarship from Tecnifar/Sociedade Portuguesa de AVC.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Fragata, I., Canto-Moreira, N. & Canhão, P. Comparison of cerebral perfusion in perimesencephalic subarachnoid hemorrhage and aneurysmal subarachnoid hemorrhage. Neuroradiology 60, 609–616 (2018). https://doi.org/10.1007/s00234-018-1997-1

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  • DOI: https://doi.org/10.1007/s00234-018-1997-1

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