Clinical, Transcranial Doppler Ultrasound, Radiological Features and, Prognostic Significance of Delayed Cerebral Ischem
Objective: We aimed to investigate the profiles and prognostic values of delayed cerebral ischemia (DCI) and delayed cerebral infarction.
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Abstract Objective: We aimed to investigate the profiles and prognostic values of delayed cerebral ischemia (DCI) and delayed cerebral infarction. Methods: IMASH (Intravenous Magnesium Sulphate for Aneurysmal Subarachnoid Hemorrhage) was registered at http:// www.strokecenter.org/trials, and http://www.ClinicalTrials .gov (NCT00124150). Data of 327 patients were retrieved for logistic regression analyses. Results: Seventy-one (22%) patients developed DCI, and 35 (11%) patients developed delayed cerebral infarction. Only 18 (25%) patients with DCI and 7/35 (20%) patients with delayed cerebral infarction had mean middle cerebral artery velocities (transcranial Doppler ultrasound) over 120 cm/s. Regarding the prognostic significance of the components of DCI, delayed cerebral infarction predicted unfavorable outcome in terms of Extended Glasgow Outcome Scale (OR 3.1, 95% [CI] 1.3–7.8), poor outcome in terms of modified Rankin Scale (odds ratio [OR] 3.0, 95% confidence interval CI 1.2–7.7), and dependent activity of daily living in terms of Barthel Index (OR 3.6, 95% CI 1.4–9.2) at 6 months, after adjustments for other prognostic factors. On the other hand, clinical deterioration predicted inpatient mortality (OR 8.8, 95% CI 1.6–48.8) after adjustments for other prognostic factors. Conclusions: Delayed cerebral ischemia and delayed cerebral infarction carried different prognostic values in aneurysmal subarachnoid hemorrhage.
Introduction
Keywords Aneurysm • Cerebral infarction • Delayed cerebral ischemia • Stroke • Subarachnoid hemorrhage
Methods
G.K.C. Wong, M.D. () Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China Department of Surgery, 4/F Clinical Science Building, Prince of Wales Hospital, 1 Ngan Shing Street, Shatin, Hong Kong SAR, China e-mail: [email protected] W.S. Poon, FRCS Division of Neurosurgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
Although spontaneous subarachnoid hemorrhage (SAH) accounts for only 3–5% of all strokes and 4.4% of deaths from stroke [1, 2], the relative youth of the affected individuals means that this event is actually responsible for approximately 25% of all years of life lost as a result of stroke [3]. Complications, such as early brain injuries and delayed ischemic neurological deficits, remain a major cause of morbidity and mortality in this group of patients. The recently completed Asian-Australasian Intravenous Magnesium Sulphate for Aneurysmal Subarachnoid Hemorrhage (IMASH) trial, a randomized, double-blind, placebo-controlled, multicenter, phase III trial, as well as an updated meta-analysis, did not demonstrate any benefits in clinical outcome or clinical vasospasm with magnesium sulfate infusion [4–6]. However, a recently completed German, single-center, randomized, placebo-controlled trial showed no benefit in clinical outcome and delayed ischemic neurological deficit but found a decrease in delayed (after day 3 or 4) cerebral infarction with mag
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