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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


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
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