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Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome

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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.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, Knappschafts-Krankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany

    Johann Fontana, Kirsten Schmieder & Martin Barth

  2. Department of Neurosurgery, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany

    Julius Moratin & Gregory Ehrlich

  3. Department of Neuroradiology, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany

    Johann Scharf

  4. Department of Medical Statistics, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany

    Christel Weiß

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  1. Johann Fontana
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  2. Julius Moratin
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Correspondence to Martin Barth.

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Fontana, J., Moratin, J., Ehrlich, G. et al. Dynamic Autoregulatory Response After Aneurysmal Subarachnoid Hemorrhage and Its Relation to Angiographic Vasospasm and Clinical Outcome. Neurocrit Care 23, 355–363 (2015). https://doi.org/10.1007/s12028-014-0104-7

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  • DOI: https://doi.org/10.1007/s12028-014-0104-7

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