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Prediction of Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Value of the Hijdra Sum Scoring System

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Abstract

Background

Vasospasm is a major complication of aneurysmal subarachnoid hemorrhage (SAH) and affects clinical outcome. The ability to predict cerebral vasospasm after SAH would allow the neuro-intensivist to institute preemptive and more aggressive therapy.

Methods

Social, clinical, and radiological information on adult SAH patients recently admitted to our hospital were reviewed. Univariate and multivariate statistical methods were used to examine the impact of patient demographics, clinical variables, and radiologic characteristics on the development of angiographic vasospasm.

Results

One hundred and sixty three patients were identified (102 females, 63%). A total of 34 patients (21%) developed angiographic vasospasm. In univariate analysis, occurrence of cerebral vasospasm was associated with poor World Federation of Neurological Surgeons (WFNS 4–5, P = 0.003) and modified Fisher (MFS 3–4, P = 0.02) grades, elevated Hijdra sum score (HSS ≥23, P = 0.0001), female gender (P = 0.04), development of hydrocephalus (P = 0.01), and a history of tobacco use (P = 0.02). In multivariable analysis, only the HSS ≥23 (P = 0.01) and history of smoking (P = 0.02) predicted cerebral vasospasm. Combined history of smoking and HSS >23 had positive and negative predictive values of 37 and 88%, respectively, for prediction of cerebral vasospasm after aneurysmal hemorrhage.

Conclusions

Hijdra sum score and a history of smoking are the strongest predictors of cerebral vasospasm on angiography. HSS is superior to the MFS as a radiologic grading tool to predict occurrence of angiographic vasospasm after aneurysmal subarachnoid hemorrhage.

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Authors and Affiliations

  1. Departments 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 & 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. Alejandro A. Rabinstein
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Correspondence to Stefan A. Dupont.

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All authors contributed equally to the preparation of this manuscript.

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Dupont, S.A., Wijdicks, E.F.M., Manno, E.M. et al. Prediction of Angiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: Value of the Hijdra Sum Scoring System. Neurocrit Care 11, 172–176 (2009). https://doi.org/10.1007/s12028-009-9247-3

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  • DOI: https://doi.org/10.1007/s12028-009-9247-3

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