Introduction: The presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher, LeRoux, Graeb) have been established for evaluating SAH or IVH. On the other hand, no studies have assessed the radiodensity of IVH in aneurysmal SAH patients. Prior studies have suggested that hemorrhage with higher radiodensity, as measured by CT Hounsfield Units (HU), can cause more irritation to brain parenchyma. Consequently, we investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients and their clinical outcome scores.
Methods: We reviewed the records of 104 patients who were admitted to the Neurological Intensive Care Unit for aneurysmal SAH from January 2012 to October 2015. Data was collected (age, gender, Glasgow coma scale (GCS), Hunt and Hess (HH) score, modified Fisher score (mFS), location of aneurysm, need for external ventricular drain (EVD), need for long-term ventricular shunting, and Glasgow outcome score (GOS). To evaluate the radiodensity of IVH, the initial CT head was loaded into OsiriX MD (Pixmeo, Switzerland). The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. Afterwards, an averaged CT HU value was calculated from the ROI by the software.
Results: Younger age, higher GCS, lower mFS, lower HH, and no presence of EVD significantly correlated with better GOS (all p <0.05). Moreover, lower averaged CT HU value within the ventricular system significantly correlated with better outcome [GOS 4-5 (10.98 +/- 0.69 HU) compared to GOS 1-3 (14.43 +/- 1.66 HU), p = 0.028]. Values given as +/- standard error mean.
Conclusions: This study suggests that the radiodensity of IVH may also serve as a predictor for clinical outcome in patients with aneurysmal SAH.
Patient Care: A better understanding of intraventricular hemorrhage in patients with aneurysmal subarachnoid hemorrhage
Learning Objectives: 1) Understand the available literature regarding the influence of IVH in aneurysmal SAH
2) Describe the utility of radiodensity in neurological diseases
3) Identify radiodensity of the ventricular system, as measured by CT Hounsfield Units, as a predictor for clinical outcome in patients with aneurysmal SAH
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