Artikel
Relationship between perfusion deficit, vasospasm and delayed cerebral ischemia in patients with SAH
Suche in Medline nach
Autoren
Veröffentlicht: | 4. Juni 2012 |
---|
Gliederung
Text
Objective: Delayed cerebral ischemia following SAH is a serious complication that substantially worsens the outcome of patients who survive the first days after bleeding. Aim of this study was to investigate the relationship between clinical deterioration, perfusion deficit on CT and angiographic vasospasm.
Methods: We performed a restrospective study of patients with SAH who were admitted to our hospital between 2009 and 2011 and who underwent CT perfusion scans. Qualitative perfusion deficits were analyzed by CBF, CBV and MTT.
Results: 22 patients underwent CT perfusion scans after SAH because of clinical deterioration and/or increased flow velocities in the TCD. Mean age of the patients was 50 years (range 22–78). 68% had a severe SAH (Hunt + Hess III or higher) on admission, in 95% the Fisher Grade was 3 or 4. The Glasgow outcome score (GOS) at discharge from hospital was poor (> 3) in 73% of the investigated patients. In 14 cases the CT-Perfusion scan showed a perfusion deficit, the subsequent DSA showed severe vasospasm that was treated by angioplasty and/or local nimodipine infusion. 4 patients had a clinical deterioration without a perfusion deficit, in 3 of the cases no further angiography was performed, only in 1 case a DSA was performed which revealed vasospasm. In 3 patients a perfusion deficit was diagnosed without further angiographic control.
Conclusions: In most of our cases we had a good correlation between clinical deterioration, perfusion deficit in CT and vasospasm in the DSA. CT-perfusion-scans seem to be a good predictor of vasospasm in patients with severe SAH.