Acta Neurochirurgica

, Volume 159, Issue 12, pp 2319–2324 | Cite as

Disturbance of CT perfusion within 24 h after onset is associated with WFNS grade but not development of DCI in patients with aneurysmal SAH

  • Yuichi Takahashi
  • Atsushi Sasahara
  • Kei Yamazaki
  • Mayuko Inazuka
  • Hidetoshi Kasuya
Original Article - Vascular
  • 15 Downloads

Abstract

Background

Delayed cerebral ischemia (DCI) is a serious complication following aneurysmal SAH (aSAH) and remains a leading cause of morbidity and mortality. We investigated whether data from CT perfusion (CTP) within 24 h after onset are associated with DCI and its outcome.

Methods

We retrospectively examined plain CT, CTP, and CT angiography (CTA) of aSAH patients on arrival. We measured the average mean transit time (aMTT) and compared it with several clinical factors, such as the age, WFNS grade, Fisher group, delayed cerebral infarction, cerebral vasospasm, and modified Rankin scale (mRS), at 1 month. Regions of interest (ROIs) were quantitatively determined in cortical and two basal ganglia areas.

Results

Delayed cerebral ischemia (DCI) developed in 11 patients and cerebral vasospasm in 28 patients out of a total of 86 aSAH patients scanned within 24 h after onset. The average MTT was correlated with the WFNS grade (p = 0.000), but not mRS (p = 0.128), age (p = 0.759), DCI (p = 0.669), or cerebral vasospasm (p = 0.306). On the other hand, DCI was associated with the Fisher group (p = 0.0056), mRS (p = 0.0052), and cerebral vasospasm (p = 0.000). Moreover, there were no significant differences in the average MTT within 24 h after onset between territories with and without DCI, or between patients with and without DCI.

Conclusions

The current findings suggest that disturbance of CT perfusion soon after the onset is associated with the WFNS grade but not with the development of DCI. Delayed cerebral ischemia may be solely caused by cerebral vasospasm due to a clot in the cistern, but not associated with early brain injury.

Keywords

Cerebral vasospasm Delayed cerebral ischemia CT perfusion Mean transit time (MTT) 

Abbreviations

ACA

anterior cerebral artery

aMTT

average mean transit time

aSAH

aneurysmal subarachnoid hemorrhage

CBF

cerebral blood flow

CBV

cerebral blood volume

CT

computed tomography

CTA

computed tomography angiography

CT perfusion

computed tomography perfusion

DCI

delayed cerebral ischemia

ICP

intracranial pressure

MCA

middle cerebral artery

MRI

magnetic resonance imaging

mRS

modified Rankin scale

PCA

posterior cerebral artery

ROI

region of interest

WFNS

World Federation of Neurosurgical Societies

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Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryTokyo Women’s Medical University Medical Center EastTokyoJapan

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