Abstract
Background: Delayed cerebral ischemia (DCI) continues to be a major cause of morbidity and mortality in patients with aneurysmal subarachnoid hemorrhage (aSAH) because it can only be diagnosed after the onset of clinical symptoms, contributing to poor clinical outcomes and huge use of clinical resources. We hypothesized that early disturbances in cerebrovascular reactivity, noninvasively measured with functional MRI + CO2, can be a sensitive marker of brain tissue at risk for DCI.
Methods: Functional MRI exam as soon as possible after the initial bleed and after surgical treatment of the aneurysm was performed in five patients. The functional MRI exam consisted of spatial cerebrovascular reactivity measurements by the blood oxygenation level-dependent (BOLD) response to a standardized carbon dioxide challenge.
Results: Of the three patients who later developed DCI, two had abnormal functional MRI study results. The two patients without DCI had normal MRI results. Brain areas with impaired cerebrovascular reactivity on the functional MRI examination demonstrated a spatial correspondence between impaired cerebrovascular reactivity and the onset of DCI.
Conclusions: In this feasibility study, functional MRI measurements of cerebrovascular reactivity showed a spatial correspondence between impaired cerebrovascular reactivity and the onset of DCI in patients with aSAH.
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References
Suarez JI, Tarr RW, Selman WR (2006) Aneurysmal subarachnoid hemorrhage. N Engl J Med 354:387–396
Weyer GW, Nolan CP, Macdonald RL (2006) Evidence-based cerebral vasospasm management. Neurosurg Focus 21:E8
Slessarev M, Han J, Mardimae A, Prisman E, Preiss D, Volgyesi G, Ansel C, Duffin J, Fisher JA (2007) Prospective targeting and control of end-tidal CO2 and O2 concentrations. J Physiol 581:1207–1219
Vesely A, Sasano H, Volgyesi G, Somogyi R, Tesler J, Fedorko L, Grynspan J, Crawley A, Fisher JA, Mikulus D (2001) MRI mapping of cerebrovascular reactivity using square wave changes in end-tidal PCO2. Magn Reson Med 45:1011–1013
Aaslid R, Huber P, Nornes H (1984) Evaluation of cerebrovascular spasm with transcranial Doppler ultrasound. J Neurosurg 60:37–41
Carrera E, Kurtz P, Badjatia N (2010) Cerebrovascular carbon dioxide reactivity and delayed cerebral ischemia after subarachnoid hemorrhage. Arch Neurol 67:434–439
Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM (1988) Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusions. Stroke 19:963–969
Mandell D, Han J, Poublanc J, Crawley A, Stainsby J, Fisher J, Mikulis D (2008) Mapping cerebrovascular reactivity using BOLD MRI in patients with arterial steno-occlusive disease: comparison with arterial spin labeling MRI. Stroke 39:2021–2028
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da Costa, L., Fisher, J., Mikulis, D.J., Tymianski, M., Fierstra, J. (2015). Early Identification of Brain Tissue at Risk for Delayed Cerebral Ischemia After Aneurysmal Subarachnoid Hemorrhage. In: Fandino, J., Marbacher, S., Fathi, AR., Muroi, C., Keller, E. (eds) Neurovascular Events After Subarachnoid Hemorrhage. Acta Neurochirurgica Supplement, vol 120. Springer, Cham. https://doi.org/10.1007/978-3-319-04981-6_18
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DOI: https://doi.org/10.1007/978-3-319-04981-6_18
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