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Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage

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Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 127)

Abstract

Background: Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV).

Methods: Eight SAH patients underwent prospectively a median of 7 DCA assessments consisting of continuous measurements of BCFV and BP. Transfer function analysis was applied to calculate average phase shift (PS) in low (0.07–0.2 Hz) frequency range for each hemisphere as continuous measure of DCA. Lower PS indicated poorer regulatory response. DCI was defined as a 2-point decrease in Glasgow Coma Score and/or infarction on CT.

Results: Three subjects developed symptomatic vasospasm with median time-to-DCI of 9 days. DCI was significantly associated with lower PS over the entire recording period (Wald = 4.28; p = 0.039). Additionally, there was a significant change in PS over different recording periods after adjusting for DCI (Wald = 15.66; p = 0.001); particularly, a significantly lower mean PS day 3–5 after bleed (14.22 vs 27.51; p = 0.05).

Conclusions: DCA might be useful for early detection of symptomatic vasospasm. A larger cohort study of SAH patients is currently underway.

Keywords

Vasospasm Delay cerebral ischemia Dynamic cerebral autoregulation 

Abbreviations

ABP

Arterial blood pressure

aSAH

Aneurysmal subarachnoid hemorrhage

CBF

Cerebral blood flow

CBFV

Cerebral blood flow velocity

CPP

Cerebral perfusion pressure

CT

Computerized tomography

CTA

Computerized tomography angiogram

DCA

Dynamic cerebral autoregulation

DCI

Delayed cerebral ischemia

EBI

Early brain injury

FFT

Fast Fourier transformed

GCS

Glasgow Coma Scale

GEE

Generalized estimating equations

MAP

Mean arterial pressure

MCA

Middle cerebral artery

TCD

Transcranial Doppler

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Notes

Funding

No funding was received for this research.

Conflict of Interest: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and RadiologyUniversity of Iowa Hospitals and ClinicsIowaUSA
  2. 2.Department of Critical Care, Clinica AlemanaUniversidad del DesarrolloSantiagoChile
  3. 3.Department of NeurologyColumbia UniversityNew YorkUSA
  4. 4.Division of Neurocritical Care and Emergency Neurology, Department of NeurologyYale University School of MedicineNew HavenUSA

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