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Acute hydrocephalus and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage

  • Original Article - Vascular Neurosurgery - Aneurysm
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Abstract

Background

Delayed cerebral infarction (DCIn) following aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of morbi-mortality; yet, the causes for DCIn remain incompletely understood.

Objective

We tested the hypothesis that acute hydrocephalus could be related to the occurrence of DCIn, independently of the occurrence and severity of vasospasm.

Methods

Radiological and clinical data of patients treated at a single large volume academic center for aSAH between 2017 and 2019 were retrospectively analyzed. DCIn was defined as imaging stigma of cerebral infarction visible on 6-week imaging follow-up after aSAH. Hydrocephalus was defined on baseline imaging as a relative bicaudate index above 1. Cerebral vasospasm was defined by reduction of artery diameter in comparison with initial diameter. We used uni- and multivariable models to test the associations between these variables, hydrocephalus and DCIn.

Results

Of 164 included patients, vasospasm occurred in 58 patients (35.4%), and DCIn in 47 (28.7%). Acute hydrocephalus was present in 85 patients (51.8%) on baseline CT. No relation was found between acute hydrocephalus and delayed cerebral infarction in our multivariate analysis (adjusted OR: 1.20 95% CI [0.43–3.37]; p = 0.732). Only vasospasm occurrence was independently associated with DCIn (adjusted OR: 10.97 95% CI [4.60–26.01]).

Conclusion

Our study did not show an association between acute hydrocephalus and DCIn after aSAH, after adjustment for the presence and severity of cerebral vasospasm.

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Abbreviations

SAH:

Subarachnoid hemorrhage

aSAH:

Aneurysmal subarachnoid hemorrhage

DCI:

Delayed cerebral ischemia

DCIn:

Delayed cerebral infarction

CT:

Computed tomography

MRI:

Magnetic resonance imaging

WFNS:

World federation of neurosurgical surgery

BCI:

Bicaudate index

rBCI:

Relative bicaudate index

EVD:

External ventricular drainage

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Neuroradiology, Bretonneau Hospital, University of Tours, Tours, France

    Axel Masson, Grégoire Boulouis, Kevin Janot, Denis Herbreteau, Jean-Phlippe Cottier, Richard Bibi, Sandra Obry & Héloïse Ifergan

  2. Department of Diagnostic Neuroradiology, Orleans Hospital Center, Orleans, France

    Clara Cohen

  3. Department of Neurosurgery, Bretonneau Hospital, University of Tours, Tours, France

    Stéphane Velut & Aymeric Amelot

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  1. Axel Masson
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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

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Axel Masson declares that he has no conflict of interest.

Grégoire Boulouis declares that he has no conflict of interest.

Kévin Janot declares that he has no conflict of interest.

Denis Herbreteau declares that he has no conflict of interest.

Jean-Philippe Cottier declares that he has no conflict of interest.

Richard Bibi declares that he has no conflict of interest.

Clara Cohen declares that she has no conflict of interest.

Sandra Obry declares that she has no conflict of interest.

Stéphane Velut declares that he has no conflict of interest.

Aymeric Amelot declares that he has no conflict of interest.

Héloïse Ifergan declares that she has no conflict of interest.

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Masson, A., Boulouis, G., Janot, K. et al. Acute hydrocephalus and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. Acta Neurochir 164, 2401–2408 (2022). https://doi.org/10.1007/s00701-022-05321-8

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