Introduction: Delayed cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) carries significant risk for neurologic injury requiring prolonged hospital stays to monitor and treat those affected. High Hunt Hess grade is associated with an increased incidence of vasospasm, and the goal of this study was to determine if low Hunt Hess grade patients (HH I-II) with a radiographic study at the peak vasospasm incidence (6-8d) could predict late vasospasm and allow early discharge of those patients at low risk.
Methods: A retrospective review from 2004-2013 identified SAH HH I-II patients with vascular imaging completed on SAH day 6-8. Demographic, admission, and imaging data were reviewed in addition to the development of angiographic and clinical vasospasm. The patient population included both surgical (68%) and endovascular treated patients.
Results: 292 patients were included with an admission HH I-II and vascular imaging completed at 6-8 days. Vascular imaging included angiography (86%), MRA (10%), and CTA (4%). 44% of patients were found to have neither radiographic nor symptomatic clinical vasospasm. Of the 56% having radiographic vasospasm, only 8% developed symptomatic clinical vasospasm. No patient developed clinical vasospasm who had negative vascular imaging at day 6-8. Incidentally, 4 patients (1.4%) showed no vasospasm at day 6-8, but had radiographic spasm on late imaging completed for reasons unrelated to vasospasm; none of these patients developed clinical vasospasm.
Conclusions: In this retrospective review of low-grade SAH patients the incidence of radiographic vasospasm and clinical vasospasm was 56% and 8%, respectively. No patient developed symptomatic vasospasm after a vascular imaging study completed at post SAH day 6-8 was negative for radiographic vasospasm. This suggests that the duration of monitoring and, potentially, the length hospital stay could be limited in these patients, compromising 44% of the study population.
Patient Care: I believe that this will help improve patient care by better differentiating subarachnoid hemorrhage patients with respect to vasospasm. Resultant customization may potentially decrease monitoring and shorten hospital stays in appropriate patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Review the incidence of cerebral vasospasm and its associations with Fisher grade and Hunt Hess grade, 2) Discuss general surveillance of the subarachnoid hemorrhage patient, 3) Review monitoring techniques, 4) and contemplate customized surveillance based upon patient grade and surveillance monitoring results.