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Global and focal cerebral perfusion after aneurysmal subarachnoid hemorrhage in relation with delayed cerebral ischemia

By M. Rijsdijk, I.C. van der Schaaf, B.K. Velthuis, M.J.H. Wermer and G.J.E. Rinkel

Abstract

Introduction: The pathogenesis of delayed cerebral ischemia\ud (DCI) after subarachnoid hemorrhage (SAH) is unclear. We\ud assessed whether DCI relates to focal or global cerebral\ud perfusion on admission and on follow-up imaging.\ud Materials and methods: Twenty-seven SAH patients underwent\ud computed tomography (CT) perfusion (CTP) on\ud admission and at clinical deterioration or 1 week after admission\ud in clinically stable patients. We compared global and\ud focal (least perfused territory) perfusion in patients with DCI\ud (n=12), clinically stable patients (n=7), and patients with\ud non-DCI-related deterioration (n=8).\ud Results: Global cerebral blood flow (CBF) increased on\ud follow-up: 29% (95% confidence interval (CI) 15% to 43%)\ud in patients with DCI, 12% (95%CI −1% to 25%) in stable\ud patients, and 20% (95%CI 4% to 36%) in patients with non-\ud DCI-related deterioration. Focal CBF decreased in patients\ud with DCI, (−23%; 95%CI −58% to 12%) but increased in\ud patients with non-DCI-related deterioration (23%; 95%CI\ud −26%to 55%) and stable patients (7%; 95%CI −30%to 45%).\ud On follow-up, global CBF was lower in patients with DCI\ud (70.0 ml per 100 g/min) than in clinically stable patients (81.6;\ud difference 11.6; 95%CI 0.8 to 22.5 ml per 100 g/min) but\ud comparable to patients with non-DCI-related deterioration\ud (67.6; difference −2.4; 95%CI −11.9 to 7.2 ml per 100 g/min).\ud Focal CBF was lower in patients with DCI (30.7) than in\ud clinically stable patients (53.6; difference 22.9; 95%CI 5.1 to\ud 40.6 ml per 100 g/min) and patients with non-DCI-related\ud deterioration (46.6; difference 15.9; 95%CI −2.6 to 28.4 ml\ud per 100 g/min)\ud Conclusion: Our results suggest that DCI is more likely a\ud focal than a global process

Topics: Geneeskunde, Subarachnoid hemorrhage, Brain ischemia, CT perfusion, Cerebral autoregulation
Year: 2008
OAI identifier: oai:dspace.library.uu.nl:1874/29975
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