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Timing of Computed Tomography and Prediction of Vasospasm after Aneurysmal Subarachnoid Hemorrhage

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Abstract

Background

The initial noncontrast computed tomography (CT) study of the head after an aneurysmal subarachnoid hemorrhage (SAH) is used to predict the risk of developing vasospasm. Changes in the extent of subarachnoid blood seen on CT images occur as a function of time after SAH, but there is no consensus on the time interval during which this study needs to be completed.

Methods

Clinical and radiological information on adult SAH patients were reviewed. Patients were grouped based on the time elapsed from ictus to the initial head CT study. The amount of subarachnoid blood on CT was graded using the Hijdra sum score (HSS) and the modified Fisher scale (MFS). The relationship between the initial CT grading score and the risk of angiographic vasospasm was assessed for each group.

Results

A total of 224 consecutive patients were identified (145 females, 65%). Initial CT was performed within 24 h of the event in 163 (Group 1, 73%) and after 24 h in 61 patients (Group 2, 27%). A total of 54 patients (24%) developed angiographic vasospasm. A statistically significant association between the extent of subarachnoid blood and subsequent development of vasospasm was observed only if the initial CT imaging study was performed within 24 h of aneurysmal rupture (P = 0.0001 and 0.02 for HSS and MFS, respectively).

Conclusions

We propose that only CT scans obtained within 24 h of a subarachnoid bleeding event should be used to estimate the risk of vasospasm.

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References

  1. Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1–9. doi:10.1097/00006123-198001000-00001.

    Article  PubMed  CAS  Google Scholar 

  2. Frontera JA, et al. Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006;59(1):21–7, discussion 21-7. doi:10.1227/01.NEU.0000218821.34014.1B.

    Google Scholar 

  3. Hijdra A, et al. Grading the amount of blood on computed tomograms after subarachnoid hemorrhage. Stroke. 1990;21(8):1156–61.

    PubMed  CAS  Google Scholar 

  4. van Gijn J, van Dongen KJ. The time course of aneurysmal haemorrhage on computed tomograms. Neuroradiology. 1982;23(3):153–6.

    PubMed  Google Scholar 

  5. Davis JM, Davis KR, Crowell RM. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm: prognostic significance of cranial CT. Am J Roentgenol. 1980;134(4):711–5.

    CAS  Google Scholar 

  6. Gurusinghe NT, Richardson AE. The value of computerized tomography in aneurysmal subarachnoid hemorrhage. The concept of the CT score. J Neurosurg. 1984;60(4):763–70.

    Article  PubMed  CAS  Google Scholar 

  7. Kistler JP, et al. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology. 1983;33(4):424–36.

    PubMed  CAS  Google Scholar 

  8. Mizukami M, et al. Value of computed tomography in the prediction of cerebral vasospasm after aneurysm rupture. Neurosurgery. 1980;7(6):583–6. doi:10.1097/00006123-198012000-00008.

    Article  PubMed  CAS  Google Scholar 

  9. Pasqualin A, et al. Role of computed tomography in the management of vasospasm after subarachnoid hemorrhage. Neurosurgery. 1984;15(3):344–53. doi:10.1097/00006123-198409000-00009.

    Article  PubMed  CAS  Google Scholar 

  10. Reilly C, et al. Clot volume and clearance rate as independent predictors of vasospasm after aneurysmal subarachnoid hemorrhage. J Neurosurg. 2004;101(2):255–61.

    Article  PubMed  Google Scholar 

  11. Mohsen F, Pomonis S, Illingworth R. Prediction of delayed cerebral ischaemia after subarachnoid haemorrhage by computed tomography. J Neurol Neurosurg Psychiatry. 1984;47(11):1197–202. doi:10.1136/jnnp.47.11.1197.

    Article  PubMed  CAS  Google Scholar 

  12. Hijdra A, et al. Prediction of delayed cerebral ischemia, rebleeding, and outcome after aneurysmal subarachnoid hemorrhage. Stroke. 1988;19(10):1250–6.

    PubMed  CAS  Google Scholar 

  13. Brouwers PJ, Wijdicks EF, Van Gijn J. Infarction after aneurysm rupture does not depend on distribution or clearance rate of blood. Stroke. 1992;23(3):374–9.

    PubMed  CAS  Google Scholar 

  14. Brouwers PJ, et al. Amount of blood on computed tomography as an independent predictor after aneurysm rupture. Stroke. 1993;24(6):809–14.

    PubMed  CAS  Google Scholar 

  15. van der Jagt M, et al. Interobserver variability of cisternal blood on CT after aneurysmal subarachnoid hemorrhage. Neurology. 2000;54(11):2156–8.

    PubMed  Google Scholar 

  16. Claassen J, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001;32(9):2012–20. doi:10.1161/hs0901.095677.

    Article  PubMed  CAS  Google Scholar 

  17. Friedman JA, et al. Volumetric quantification of Fisher Grade 3 aneurysmal subarachnoid hemorrhage: a novel method to predict symptomatic vasospasm on admission computerized tomography scans. J Neurosurg. 2002;97(2):401–7.

    Article  PubMed  Google Scholar 

  18. Rabinstein AA, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004;35(8):1862–6. doi:10.1161/01.STR.0000133132.76983.8e.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurology and Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Stefan A. Dupont, Eelco F. M. Wijdicks, Edward M. Manno, Giuseppe Lanzino, Robert D. Brown Jr. & Alejandro A. Rabinstein

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  1. Stefan A. Dupont
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  2. Eelco F. M. Wijdicks
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  3. Edward M. Manno
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  4. Giuseppe Lanzino
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  5. Robert D. Brown Jr.
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  6. Alejandro A. Rabinstein
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Correspondence to Stefan A. Dupont.

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Dupont, S.A., Wijdicks, E.F.M., Manno, E.M. et al. Timing of Computed Tomography and Prediction of Vasospasm after Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 11, 71–75 (2009). https://doi.org/10.1007/s12028-009-9227-7

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  • DOI: https://doi.org/10.1007/s12028-009-9227-7

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