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  • The Radiodensity of Intraventricular Hemorrhage Associated with Aneurysmal Subarachnoid Hemorrhage is a Negative Predictor of Outcome

    Final Number:

    Ha Nguyen MD; Mohit Patel; Luyuan Li; Wade M Mueller MD; Shekar N. Kurpad MD, PhD

    Study Design:

    Subject Category:
    Aneurysm/Subarachnoid Hemorrhage

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    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

    References: 1. Czorlich, P., et al., Validation of the modified Graeb score in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien), 2015. 157(11): p. 1867-72. 2. Czorlich, P., et al., Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien), 2015. 157(3): p. 409-15. 3. Erixon, H.O., et al., Predictors of shunt dependency after aneurysmal subarachnoid hemorrhage: results of a single-center clinical trial. Acta Neurochir (Wien), 2014. 156(11): p. 2059-69. 4. Kramer, A.H., et al., Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. Neurosurgery, 2010. 67(4): p. 1044-52; discussion 1052-3. 5. Mayfrank, L., et al., Influence of intraventricular hemorrhage on outcome after rupture of intracranial aneurysm. Neurosurg Rev, 2001. 24(4): p. 185-91. 6. Wilson, T.J., et al., Intraventricular hemorrhage is associated with early hydrocephalus, symptomatic vasospasm, and poor outcome in aneurysmal subarachnoid hemorrhage. J Neurol Surg A Cent Eur Neurosurg, 2015. 76(2): p. 126-32.

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