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Early whole-brain CT perfusion for detection of patients at risk for delayed cerebral ischemia after subarachnoid hemorrhage.
Malinova, Vesna; Dolatowski, Karoline; Schramm, Peter; Moerer, Onnen; Rohde, Veit; Mielke, Dorothee.
Afiliação
  • Malinova V; Departments of 1 Neurosurgery.
  • Dolatowski K; Neuroradiology, and.
  • Schramm P; Neuroradiology, and.
  • Moerer O; Department of Neuroradiology, University of Lübeck, Germany.
  • Rohde V; Anaesthesiology, Georg-August-University, Göttingen; and.
  • Mielke D; Departments of 1 Neurosurgery.
J Neurosurg ; 125(1): 128-36, 2016 07.
Article em En | MEDLINE | ID: mdl-26684786
OBJECT This prospective study investigated the role of whole-brain CT perfusion (CTP) studies in the identification of patients at risk for delayed ischemic neurological deficits (DIND) and of tissue at risk for delayed cerebral infarction (DCI). METHODS Forty-three patients with aneurysmal subarachnoid hemorrhage (aSAH) were included in this study. A CTP study was routinely performed in the early phase (Day 3). The CTP study was repeated in cases of transcranial Doppler sonography (TCD)-measured blood flow velocity (BFV) increase of > 50 cm/sec within 24 hours and/or on Day 7 in patients who were intubated/sedated. RESULTS Early CTP studies revealed perfusion deficits in 14 patients, of whom 10 patients (72%) developed DIND, and 6 of these 10 patients (60%) had DCI. Three of the 14 patients (21%) with early perfusion deficits developed DCI without having had DIND, and the remaining patient (7%) had neither DIND nor DCI. There was a statistically significant correlation between early perfusion deficits and occurrence of DIND and DCI (p < 0.0001). A repeated CTP was performed in 8 patients with a TCD-measured BFV increase > 50 cm/sec within 24 hours, revealing a perfusion deficit in 3 of them (38%). Two of the 3 patients (67%) developed DCI without preceding DIND and 1 patient (33%) had DIND without DCI. In 4 of the 7 patients (57%) who were sedated and/or comatose, additional CTP studies on Day 7 showed perfusion deficits. All 4 patients developed DCI. CONCLUSIONS Whole-brain CTP on Day 3 after aSAH allows early and reliable identification of patients at risk for DIND and tissue at risk for DCI. Additional CTP investigations, guided by TCD-measured BFV increase or persisting coma, do not contribute to information gain.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hemorragia Subaracnóidea / Tomografia Computadorizada por Raios X / Infarto Cerebral / Vasoespasmo Intracraniano Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2016 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hemorragia Subaracnóidea / Tomografia Computadorizada por Raios X / Infarto Cerebral / Vasoespasmo Intracraniano Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Prognostic_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2016 Tipo de documento: Article