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Neurocritical Care

, Volume 19, Issue 3, pp 293–298 | Cite as

Infarct Volume Predicts Delayed Recovery in Patients with Subarachnoid Hemorrhage and Severe Neurological Deficits

  • Neil F. Rosenberg
  • Storm M. Liebling
  • Adam R. Kosteva
  • Matthew B. Maas
  • Shyam Prabhakaran
  • Andrew M. Naidech
ORIGINAL ARTICLE

Abstract

Background

Recovery is common after subarachnoid hemorrhage (SAH), even in patients who are severely disabled at hospital discharge. Little is known about predictors of late recovery in such patients, even though such knowledge may influence treatment decisions. We hypothesized that cerebral infarction volume would be associated with 3 months outcomes in patients who are severely disabled at 14 days.

Methods

We prospectively identified consecutive aneurysmal SAH patients, documented the development of cerebral infarction, and ascertained the modified Rankin Scale (mRS) at 14 days and 3 months. We included patients with mRS 4 or 5 and NIH Stroke Scale (NIHSS) at least 8 on hospital day 14 (i.e., severe neurologic impairment) and calculated infarct volume in a semi-automated fashion using CT imaging. We explored outcome determinants with ordinal regression.

Results

At 14 days, 66 patients were severely disabled, 65 (98.5 %) of whom had mRS of 5; the median NIHSS was 21 [14–24]. At 3 months, 20 (32.8 %) of the 61 patients with known outcomes were independent. Larger infarction volumes were associated with death (20.4 vs. 0.85 mL, P = 0.02). In ordinal regression, increased infarct volume was associated with the worse mRS after correction for WFNS grade, age, and withdrawal of life support (OR 1.01 per mL of infarct, 95 % CI 1.01–1.03, P = 0.01).

Conclusions

After SAH, even with severe neurological injury at 14 days, good recovery is frequent and is associated with lower infarction volume. These data may help clinicians inform surrogate decision makers as they plan the future care of such severely disabled patients.

Keywords

Subarachnoid hemorrhage Prognosis Cerebral infarction 

Notes

Acknowledgments

This work was departmentally funded. The infrastructure for automated data retrieval was funded in part by National Institutes of Health through a Grant to Northwestern University’s Clinical and Translational Sciences (NUCATS) UL1RR025741. Dr. Rosenberg received support from the Goldberg Charitable Trust of Northwestern Memorial Hospital to present these data in abstract form at the American Academy of Neurology Annual Meeting.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Neil F. Rosenberg
    • 1
  • Storm M. Liebling
    • 1
  • Adam R. Kosteva
    • 1
  • Matthew B. Maas
    • 1
    • 2
  • Shyam Prabhakaran
    • 1
  • Andrew M. Naidech
    • 1
    • 2
    • 3
  1. 1.Section on Neurocritical Care, Ken & Ruth Davee Department of NeurologyNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of AnesthesiologyNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Department of Neurological SurgeryNorthwestern University Feinberg School of MedicineChicagoUSA

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