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Corticothalamic Connectivity in Aneurysmal Subarachnoid Hemorrhage: Relationship with Disordered Consciousness and Clinical Outcomes

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Abstract

Background

We present an exploratory analysis of the occurrence of early corticothalamic connectivity disruption after aneurysmal subarachnoid hemorrhage (SAH) and its correlation with clinical outcomes.

Methods

We conducted a retrospective study of patients with acute SAH who underwent continuous electroencephalography (EEG) for impairment of consciousness. Only patients undergoing endovascular aneurysm treatment were included. Continuous EEG tracings were reviewed to obtain artifact-free segments. Power spectral analyses were performed, and segments were classified as A (only delta power), B (predominant delta and theta), C (predominant theta and beta), or D (predominant alpha and beta). Each incremental category from A to D implies greater preservation of corticothalamic connectivity. We dichotomized categories as AB for poor connectivity and CD for good connectivity. The modified Rankin Scale score at follow-up and in-hospital mortality were used as outcome measures.

Results

Sixty-nine patients were included, of whom 58 had good quality EEG segments for classification: 28 were AB and 30 were CD. Hunt and Hess and World Federation of Neurological Surgeons grades were higher and the initial Glasgow Coma Scale score was lower in the AB group compared with the CD group. AB classification was associated with an adjusted odds ratio of 5.71 (95% confidence interval 1.61–20.30; p < 0.01) for poor outcome (modified Rankin Scale score 4–6) at a median follow-up of 4 months (interquartile range 2–6) and an odds ratio of 5.6 (95% confidence interval 0.98–31.95; p = 0.03) for in-hospital mortality, compared with CD.

Conclusions

EEG spectral-power-based classification demonstrates early corticothalamic connectivity disruption following aneurysmal SAH and may be a mechanism involved in early brain injury. Furthermore, the extent of this disruption appears to be associated with functional outcome and in-hospital mortality in patients with aneurysmal SAH and appears to be a potentially useful predictive tool that must be validated prospectively.

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Funding

Dr. Forgacs reports grants from the National Institute of Neurological Disorders and Stroke (Grant No. K23-NS096222), grants from the Leon Levy Neuroscience Fellowship Award, grants from the National Center for Advancing Translational Sciences (Grant No. UL1-TR000043), grants from the Rockefeller Clinical and Translational Science Award Program, and grants from the Stavros Niarchos Foundation during the conduct of the study. Dr. Allen has nothing to disclose. Ms. Wu reports grants from the National Center for Advancing Translational Sciences. Dr. Gerber reports grants from the National Center for Advancing Translational Sciences. Dr. Boddu has nothing to disclose. Dr. Fakhar has nothing to disclose. Dr. Stieg has nothing to disclose. Dr. Schiff reports grants from the National Institute of Neurological Disorders and Stroke (Grant No. RO1-HD051912), grants from the James S. McDonnell Foundation, and grants from the Jerold B. Katz Foundation. Dr. Mangat has nothing to disclose.

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Author notes

  1. Peter B. Forgacs and Baxter B. Allen have contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, 525 E 68 Street, 610, New York, NY, 10065, USA

    Peter B. Forgacs, Baxter B. Allen, Malik Fakhar, Nicholas D. Schiff & Halinder S. Mangat

  2. Department of Population Health Sciences, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, USA

    Xian Wu & Linda M. Gerber

  3. Department of Neurological Surgery, Weill Cornell Brain and Spine Institute, Weill Cornell Medicine, New York, NY, USA

    Srikanth Boddu, Philip E. Stieg & Halinder S. Mangat

  4. Department of Neurology, University of Arizona College of Medicine, Phoenix, AZ, USA

    Malik Fakhar

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Contributions

Peter B. Forgacs, MD, designed and conceptualized the study, analyzed and interpreted the data, and drafted the manuscript for intellectual content. Baxter B. Allen, MD, designed and conceptualized the study, analyzed and interpreted the data, and drafted and revised the manuscript for intellectual content. Xian Wu, MPH, analyzed the data and drafted the manuscript for intellectual content. Linda M. Gerber, PhD, analyzed the data and drafted the manuscript for intellectual content. Srikanth Boddu, MD, contributed a major role in the acquisition of data and revised the manuscript for intellectual content. Malik Fakhar, MD, contributed a major role in the acquisition of data. Phillip E. Stieg, PhD, MD, designed and conceptualized the study. Nicholas D. Schiff, MD, designed and conceptualized the study and revised the manuscript for intellectual content. Halinder S. Mangat, MD, designed and conceptualized the study, interpreted the data, and drafted and revised the manuscript for intellectual content.

Corresponding author

Correspondence to Halinder S. Mangat.

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The institutional review board for research integrity at Weill Cornell Medicine approved the study, and all ethical guidelines were adhered to.

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Forgacs, P.B., Allen, B.B., Wu, X. et al. Corticothalamic Connectivity in Aneurysmal Subarachnoid Hemorrhage: Relationship with Disordered Consciousness and Clinical Outcomes. Neurocrit Care 36, 760–771 (2022). https://doi.org/10.1007/s12028-021-01354-6

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  • DOI: https://doi.org/10.1007/s12028-021-01354-6

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