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  • A Novel Predictor for Delayed Cerebral Infarction During Subarachnoid Hemorrhage Using Vasospasm Scoring System

    Final Number:

    Mikio Maruwaka; Akino Kawamura; Masaki Sumitomo MD; Eiji Tachibana MD, PhD; Koichiro Ogura MD, PhD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: The prediction of cerebral vasospasm and delayed cerebral infarction after the onset of subarachnoid hemorrhage is one of most challenging issues in clinical situations. Many clinicians have been trying to uncover the pathogenesis of SAH vasospasm and delayed cerebral infarction after SAH, but not fully has been elucidated.

    Methods: 90 consecutive SAH patients who were treated from 2014 to 2016 in our department were evaluated. We developed a novel scoring system for cerebral vasospasm(VS) by magnetic resonance angiography time of flight (MRA-TOF) images and maximum intensity projection (MIP) images by the severity of vasospasm; none;0 mild:1 moderate 2 severe:3. We defined the delayed cerebral infarction as diffusion weighted image (DWI) high intesnsity during SAH vasospasm period not directly caused by the surgery. And the occurrence of paralysis, aphasia, dysphasia and conscious disturbance in vasospasm period were determined as symptomatic vasospasm (SVS). The vasospasm scoring, WFNS classification, Fisher group, modified Rankin scale at discharge were evaluated by multivariable analysis.

    Results: 15% cases of patients developed DCI. 70% of patients were diagnosed as cerebral vasospasm. On multivariable analysis, the vasospasm scores and delayed cerebral infarction were correlated with suboptimal sensitivity and specificity. But the artifact formation of MRA in the clipping surgery and the overestimate of cerebral vasospasm may still remain.

    Conclusions: The vasospasm scoring system using MRA-TOF and MIP images is a good predictor for the detection of early vasospasm and cerebral infarction in SAH.

    Patient Care: If the prediction of the post SAH vasospasm and delayed cerebral infarction is possible, we can reinforce the anti-vasospasm therapy correctively and can also improve the rate of post SAH cerebral infarction and prognosis of the affected patients.

    Learning Objectives: cerebral vasospasm, delayed cerebral infarction


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