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Impaired Cerebrovascular Reactivity in the Early Phase of Subarachnoid Hemorrhage in Good Clinical Grade Patients Does Not Predict Vasospasm

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Neurovascular Events After Subarachnoid Hemorrhage

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 120))

Abstract

Objective: Subarachnoid hemorrhage (SAH) alters cerebrovascular reactivity (CVR) to carbon dioxide (CO2), which may be related to an increased risk of delayed ischemic neurological deficits (DINDs). We report the results of bedside CVR testing in the acute phase of SAH in good clinical grade patients without established vasospasm or signs of DIND.

Materials and Methods: Eighteen patients with SAH and 26 healthy subjects underwent CVR testing using transcranial Doppler with standardized changes in CO2. None of the patients had clinical or radiological evidence of vasospasm or DIND at time of testing. A CVR index was calculated as the change in the middle cerebral artery blood flow velocity (MCAv) divided by the change in the end-tidal CO2 partial pressure (PCO2), ∆ MCAv/Δ PCO2 , and values were compared with controls.

Results: SAH patients had lower CVR when compared with normal controls (p = 0.0001 and p = 0.0094, respectively). Impaired CVR was not correlated with future vasospasm (p = 0.2).

Conclusions: Patients with SAH had significantly lower CVR indexes compared with healthy controls. Although impaired CVR was present in 50 % of the patients early after SAH, no correlation with later occurrence of DINDs was found.

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Conflict of Interest Statement

Joseph Fisher is senior scientist and Director of Thornhill Research, company that invented and produces the Respiract™.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room A1-37, Toronto, ON, M4N 3M5, Canada

    Leodante da Costa MD

  2. Department of Medical Imaging, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada

    Leodante da Costa MD

  3. Department of Neuromonitoring, Medical Imaging, The Ottawa Hospital, University of Ottawa, Toronto, ON, Canada

    David Houlden PhD

  4. Interdepartmental Division of Critical Care, Sunnybrook Hospital, University of Toronto, Toronto, ON, Canada

    Gordon Rubenfeld MD, MSc

  5. Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University Health Network, University of Toronto, Toronto, ON, Canada

    Michael Tymianski MD, PhD

  6. Department of Anesthesia, Toronto General Hospital and University Health Network, University of Toronto, Toronto, ON, Canada

    Joseph Fisher MD

  7. Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland

    Jorn Fierstra MD, PhD

Authors
  1. Leodante da Costa MD
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  2. David Houlden PhD
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  3. Gordon Rubenfeld MD, MSc
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  4. Michael Tymianski MD, PhD
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  5. Joseph Fisher MD
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  6. Jorn Fierstra MD, PhD
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Corresponding author

Correspondence to Leodante da Costa MD .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Javier Fandino

  2. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Serge Marbacher

  3. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Ali-Reza Fathi

  4. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Carl Muroi

  5. Department of Neurosurgery Neurointensive Care Unit, University Hospital Zurich, Zurich, Switzerland

    Emanuela Keller

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da Costa, L., Houlden, D., Rubenfeld, G., Tymianski, M., Fisher, J., Fierstra, J. (2015). Impaired Cerebrovascular Reactivity in the Early Phase of Subarachnoid Hemorrhage in Good Clinical Grade Patients Does Not Predict Vasospasm. 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_42

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  • DOI: https://doi.org/10.1007/978-3-319-04981-6_42

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04980-9

  • Online ISBN: 978-3-319-04981-6

  • eBook Packages: MedicineMedicine (R0)

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