Skip to main content

Advertisement

SpringerLink
Log in

Default Mode Network Perfusion in Aneurysmal Subarachnoid Hemorrhage

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Background

The etiology of altered consciousness in patients with high-grade aneurysmal subarachnoid hemorrhage (SAH) is not thoroughly understood. We hypothesized that decreased cerebral blood flow (CBF) in brain regions critical to consciousness may contribute.

Methods

We retrospectively evaluated arterial-spin labeled (ASL) perfusion magnetic resonance imaging (MRI) measurements of CBF in 12 patients with aneurysmal SAH admitted to our neurocritical care unit. CBF values were analyzed within gray matter nodes of the default mode network (DMN), whose functional integrity has been shown to be necessary for consciousness. DMN nodes studied were the bilateral medial prefrontal cortices, thalami, and posterior cingulate cortices. Correlations between nodal CBF and admission Glasgow Coma Scale (GCS) score, admission Hunt and Hess (HH) class, and GCS score at the time of MRI (MRI GCS) were tested.

Results

Spearman’s correlation coefficients were not significant when comparing admission GCS, admission HH, and MRI GCS versus nodal CBF (p > 0.05). However, inter-rater reliability for nodal CBF was high (r = 0.71, p = 0.01).

Conclusions

In this retrospective pilot study, we did not identify significant correlations between CBF and admission GCS, admission HH class, or MRI GCS for any DMN node. Potential explanations for these findings include small sample size, ASL data acquisition at variable times after SAH onset, and CBF analysis in DMN nodes that may not reflect the functional integrity of the entire network. High inter-rater reliability suggests ASL measurements of CBF within DMN nodes are reproducible. Larger prospective studies are needed to elucidate whether decreased cerebral perfusion contributes to altered consciousness in SAH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kobayashi K, Ishii R, Koike T, Ihara I, Kameyama S. Cerebral blood flow and metabolism in patients with ruptured aneurysms. Acta Neurol Scand Suppl. 1979;60:492–3.

    Google Scholar 

  2. Hadeishi H, Suzuki A, Yasui N, Hatazawa J, Shimosegawa E. Diffusion-weighted magnetic resonance imaging in patients with subarachnoid hemorrhage. Neurosurgery. 2002;50:741–8.

    Article  PubMed  Google Scholar 

  3. Sato K, Shimizu H, Fujimura M, Inoue T, Matsumoto Y, Tominaga T. Acute-stage diffusion-weighted magnetic resonance imaging for predicting outcome of poor-grade aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2010;30:1110–20.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wartenberg KE, Sheth SJ, Schmidt JM, et al. Acute ischemic injury on diffusion-weighted magnetic resonance imaging after poor grade subarachnoid hemorrhage. Neurocrit Care. 2011;14:407–15.

    Article  PubMed  Google Scholar 

  5. Frontera JA, Ahmed W, Zach V, et al. Acute ischaemia after subarachnoid hemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study. J Neurol Neurosurg Psychiatry. 2015;86:71–8.

    Article  PubMed  Google Scholar 

  6. Grubb RL Jr, Raichle ME, Eichling JO, Gado MH. Effects of subarachnoid hemorrhage on cerebral blood volume, blood flow, and oxygen utilization in humans. J Neurosurg. 1977;46:446–53.

    Article  PubMed  Google Scholar 

  7. Ishii R. Regional cerebral blood flow in patients with ruptured intracranial aneurysms. J Neurosurg. 1979;50:587–94.

    Article  CAS  PubMed  Google Scholar 

  8. Hasan D, van Peski J, Loeve I, Krenning EP, Vermeulen M. Single photon emission computed tomography in patients with acute hydrocephalus or with cerebral ischaemia after subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry. 1991;54:490–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Bishop CC, Powell S, Rutt D, Browse NL. Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke. 1986;17:913–5.

    Article  CAS  PubMed  Google Scholar 

  10. Miranda P, Lagares A, Alen J, Perez-Nunez A, Arrese I, Lobato RD. Early transcranial Doppler after subarachnoid hemorrhage: clinical and radiological correlations. Surg Neurol. 2006;65:247–52.

    Article  PubMed  Google Scholar 

  11. Lui YW, Tang ER, Allmendinger AM, Spektor V. Evaluation of CT perfusion in the setting of cerebral ischemia: patterns and pitfalls. AJNR Am J Neuroradiol. 2010;31:1552–63.

    Article  CAS  PubMed  Google Scholar 

  12. Lagares A, Cicuendez M, Ramos A, et al. Acute perfusion changes after spontaneous SAH: a perfusion CT study. Acta Neurochir. 2012;154:405–12.

    Article  PubMed  Google Scholar 

  13. Hirano T. Searching for salvageable brain: the detection of ischemic penumbra using various imaging modalities? J Stroke Cerebrovasc Dis. 2014;23:795–8.

    Article  PubMed  Google Scholar 

  14. Kim MN, Edlow BL, Durduran T, et al. Continuous optical monitoring of cerebral hemodynamics during head-of-bed manipulation in brain-injured adults. Neurocrit Care. 2014;20:443–53.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gunther M. Perfusion imaging. J Magn Reson Imaging. 2014;40:269–79.

    Article  PubMed  Google Scholar 

  16. Detre JA, Leigh JS, Williams DS, Koretsky AP. Perfusion imaging. Magn Reson Med. 1992;23:37–45.

    Article  CAS  PubMed  Google Scholar 

  17. Aoyama K, Fushimi Y, Okada T, et al. Detection of symptomatic vasospasm after subarachnoid haemorrhage: initial findings from single time-point and serial measurements with arterial spin labeling. Eur Radiol. 2012;22:2382–91.

    Article  PubMed  Google Scholar 

  18. Kelly ME, Rowland MJ, Okell TW, et al. Pseudo-continuous arterial spin labelling MRI for non-invasive, whole-brain, serial quantification of cerebral blood flow following aneurysmal subarachnoid hemorrhage. Transl Stroke Res. 2013;4:710–8.

    Article  CAS  PubMed  Google Scholar 

  19. Labriffe M, Ter Minassian A, Pasco-Papon A, N’Guyen S, Aube C. Feasibility and validity of monitoring subarachnoid hemorrhage by a noninvasive MRI imaging perfusion technique: pulsed arterial spin labelling (PASL). J Neuroradiol. 2015;. doi:10.1016/j.neurad.2015.04.001.

    PubMed  Google Scholar 

  20. Fernandez-Seara MA, Edlow BL, Hoang A, Wang J, Feinberg DA, Detre JA. Minimizing acquisition time of arterial spin labeling at 3T. Magn Reson Med. 2008;59:1467–71.

    Article  PubMed  Google Scholar 

  21. Chen Y, Wang DJ, Detre JA. Test-retest reliability of arterial spin labeling with common labeling strategies. J Magn Reson Imaging. 2011;33:47–57.

    Google Scholar 

  22. Liu AA, Voss HU, Dyke JP, Heier LA, Schiff ND. Arterial spin labeling and altered cerebral blood flow patterns in the minimally conscious state. Neurology. 2011;77:1518–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJ, et al. Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain. 2010;133:161–71.

    Article  PubMed  Google Scholar 

  24. Fernandez-Espejo D, Soddu A, Cruse D, et al. A role for the default mode network in the bases of disorders of consciousness. Ann Neurol. 2012;72:335–43.

    Article  PubMed  Google Scholar 

  25. Norton L, Hutchison RM, Young GB, Lee DH, Sharpe MD, Mirsattari SM. Disruptions of functional connectivity in the default mode network of comatose patients. Neurology. 2012;78:175–81.

    Article  CAS  PubMed  Google Scholar 

  26. Koenig MA, Holt JL, Ernst T, et al. MRI default mode network connectivity is associated with functional outcome after cardiopulmonary arrest. Neurocrit Care. 2014;20:348–57.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Buckner RL, Andrews-Hanna JR, Schacter DL, et al. The brain’s default network: anatomy, function, and relevance to disease. Ann N Y Acad Sci. 2008;1124:1–38.

    Article  PubMed  Google Scholar 

  28. Demertzi A, Soddu A, Laureys S. Consciousness supporting networks. Curr Opin Neurobiol. 2013;23:239–44.

    Article  CAS  PubMed  Google Scholar 

  29. Grote E, Hassler W. The critical first minutes after subarachnoid hemorrhage. Neurosurgery. 1988;22:654–61.

    Article  CAS  PubMed  Google Scholar 

  30. Friedrich V, Flores R, Muller A, Sehba FA. Luminal platelet aggregates in functional deficits in parenchymal vessels after subarachnoid hemorrhage. Brain Res. 2010;1354:179–87.

    Article  CAS  PubMed  Google Scholar 

  31. Seeley WW, Menon V, Schatzberg AF, et al. Dissociable intrinsic connectivity networks for salience processing and executive control. J Neurosci. 2007;27:1249–56.

    Article  Google Scholar 

  32. Gunther M, Oshio K, Feinberg DA. Single-shot 3D imaging techniques improve arterial spin labeling perfusion measurements. Magn Reson Med. 2005;54:491–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was conducted with support from Harvard Catalyst and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. The authors also acknowledge Ms. Camille A. Spencer, who assisted with the statistical analyses.

Author information

Authors and Affiliations

  1. Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA

    Sarah Nelson, Brian L. Edlow, Eric S. Rosenthal, M. Brandon Westover & Guy Rordorf

  2. Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA

    Brian L. Edlow & Ona Wu

  3. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Ona Wu

Authors
  1. Sarah Nelson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian L. Edlow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ona Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric S. Rosenthal
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Brandon Westover
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guy Rordorf
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sarah Nelson.

Ethics declarations

Conflict of Interest

Dr. Westover is supported by the following grants: NIH-NINDS 1K23NS090900, The Rappaport Foundation, and the Andrew David Heitman Neuroendovascular Research Fund. Drs. Nelson, Edlow, Wu, Rosenthal, and Rordorf have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institution and with the 1964 Helsinki declaration and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nelson, S., Edlow, B.L., Wu, O. et al. Default Mode Network Perfusion in Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care 25, 237–242 (2016). https://doi.org/10.1007/s12028-016-0244-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-016-0244-z

Keywords

Search

Navigation