Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage

Alejandro Rabinstein, Jonathan A. Friedman, Stephen D. Weigand, Robyn L. McClelland, Jimmy R. Fulgham, Edward M. Manno, John L D Atkinson, Eelco F M Wijdicks

Research output: Contribution to journalArticle

236 Citations (Scopus)

Abstract

Background - Clinical and radiologic predictors of cerebral infarction occurrence and location after aneurysmal subarachnoid hemorrhage have been seldom studied. Methods - We evaluated all patients admitted to our hospital with aneurysmal subarachnoid hemorrhage between 1998 and 2000. Cerebral infarction was defined as a new hypodensity located in a vascular distribution on computed tomography (CT) scan. Results - Fifty-seven of 143 patients (40%) developed a cerebral infarction. On univariate analysis, occurrence of cerebral infarction was associated with a worse World Federation of Neurological Surgeons grade (P=0.01), use of ventriculostomy catheter (P=0.01), preoperative vasospasm (P=0.03), surgical clipping (P=0.02), symptomatic vasospasm (P<0.01), and vasospasm on transcranial Doppler ultrasonography (TCD) or repeat angiogram (P<0.01). On multivariable analysis, only presence of symptoms ascribed to vasospasm (P<0.01) and evidence of vasospasm on TCD or angiogram predicted cerebral infarction (P<0.01). TCD and angiogram agreed on the diagnosis of vasospasm in 73% of cases (95% CI, 63% to 81%), but the diagnostic accuracy of this combination of tests was suboptimal for the prediction of cerebral infarction occurrence (sensitivity, 0.72; specificity, 0.68; positive predictive value, 0.67; negative predictive value, 0.72). Location of the cerebral infarction on delayed CT was predicted by neurological symptoms in 74%, by aneurysm location in 77%, and by angiographic vasospasm in 67%. Conclusions - Evidence of vasospasm on TCD and angiogram is predictive of cerebral infarction on CT scan but sensitivity and specificity are suboptimal. Cerebral infarction location cannot be predicted in one quarter to one third of patients by any of the studied clinical or radiological variables.

Original languageEnglish (US)
Pages (from-to)1862-1866
Number of pages5
JournalStroke
Volume35
Issue number8
DOIs
StatePublished - Aug 2004

Fingerprint

Cerebral Infarction
Subarachnoid Hemorrhage
Doppler Transcranial Ultrasonography
Angiography
Tomography
Ventriculostomy
Sensitivity and Specificity
Aneurysm
Blood Vessels
Catheters

Keywords

  • Cerebral angiography
  • Forecasting
  • Stroke
  • Subarachnoid hemorrhage
  • Ultrasonography, transcranial, Doppler

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Rabinstein, A., Friedman, J. A., Weigand, S. D., McClelland, R. L., Fulgham, J. R., Manno, E. M., ... Wijdicks, E. F. M. (2004). Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke, 35(8), 1862-1866. https://doi.org/10.1161/01.STR.0000133132.76983.8e

Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. / Rabinstein, Alejandro; Friedman, Jonathan A.; Weigand, Stephen D.; McClelland, Robyn L.; Fulgham, Jimmy R.; Manno, Edward M.; Atkinson, John L D; Wijdicks, Eelco F M.

In: Stroke, Vol. 35, No. 8, 08.2004, p. 1862-1866.

Research output: Contribution to journalArticle

Rabinstein, A, Friedman, JA, Weigand, SD, McClelland, RL, Fulgham, JR, Manno, EM, Atkinson, JLD & Wijdicks, EFM 2004, 'Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage', Stroke, vol. 35, no. 8, pp. 1862-1866. https://doi.org/10.1161/01.STR.0000133132.76983.8e
Rabinstein A, Friedman JA, Weigand SD, McClelland RL, Fulgham JR, Manno EM et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004 Aug;35(8):1862-1866. https://doi.org/10.1161/01.STR.0000133132.76983.8e
Rabinstein, Alejandro ; Friedman, Jonathan A. ; Weigand, Stephen D. ; McClelland, Robyn L. ; Fulgham, Jimmy R. ; Manno, Edward M. ; Atkinson, John L D ; Wijdicks, Eelco F M. / Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. In: Stroke. 2004 ; Vol. 35, No. 8. pp. 1862-1866.
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abstract = "Background - Clinical and radiologic predictors of cerebral infarction occurrence and location after aneurysmal subarachnoid hemorrhage have been seldom studied. Methods - We evaluated all patients admitted to our hospital with aneurysmal subarachnoid hemorrhage between 1998 and 2000. Cerebral infarction was defined as a new hypodensity located in a vascular distribution on computed tomography (CT) scan. Results - Fifty-seven of 143 patients (40{\%}) developed a cerebral infarction. On univariate analysis, occurrence of cerebral infarction was associated with a worse World Federation of Neurological Surgeons grade (P=0.01), use of ventriculostomy catheter (P=0.01), preoperative vasospasm (P=0.03), surgical clipping (P=0.02), symptomatic vasospasm (P<0.01), and vasospasm on transcranial Doppler ultrasonography (TCD) or repeat angiogram (P<0.01). On multivariable analysis, only presence of symptoms ascribed to vasospasm (P<0.01) and evidence of vasospasm on TCD or angiogram predicted cerebral infarction (P<0.01). TCD and angiogram agreed on the diagnosis of vasospasm in 73{\%} of cases (95{\%} CI, 63{\%} to 81{\%}), but the diagnostic accuracy of this combination of tests was suboptimal for the prediction of cerebral infarction occurrence (sensitivity, 0.72; specificity, 0.68; positive predictive value, 0.67; negative predictive value, 0.72). Location of the cerebral infarction on delayed CT was predicted by neurological symptoms in 74{\%}, by aneurysm location in 77{\%}, and by angiographic vasospasm in 67{\%}. Conclusions - Evidence of vasospasm on TCD and angiogram is predictive of cerebral infarction on CT scan but sensitivity and specificity are suboptimal. Cerebral infarction location cannot be predicted in one quarter to one third of patients by any of the studied clinical or radiological variables.",
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T1 - Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage

AU - Rabinstein, Alejandro

AU - Friedman, Jonathan A.

AU - Weigand, Stephen D.

AU - McClelland, Robyn L.

AU - Fulgham, Jimmy R.

AU - Manno, Edward M.

AU - Atkinson, John L D

AU - Wijdicks, Eelco F M

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N2 - Background - Clinical and radiologic predictors of cerebral infarction occurrence and location after aneurysmal subarachnoid hemorrhage have been seldom studied. Methods - We evaluated all patients admitted to our hospital with aneurysmal subarachnoid hemorrhage between 1998 and 2000. Cerebral infarction was defined as a new hypodensity located in a vascular distribution on computed tomography (CT) scan. Results - Fifty-seven of 143 patients (40%) developed a cerebral infarction. On univariate analysis, occurrence of cerebral infarction was associated with a worse World Federation of Neurological Surgeons grade (P=0.01), use of ventriculostomy catheter (P=0.01), preoperative vasospasm (P=0.03), surgical clipping (P=0.02), symptomatic vasospasm (P<0.01), and vasospasm on transcranial Doppler ultrasonography (TCD) or repeat angiogram (P<0.01). On multivariable analysis, only presence of symptoms ascribed to vasospasm (P<0.01) and evidence of vasospasm on TCD or angiogram predicted cerebral infarction (P<0.01). TCD and angiogram agreed on the diagnosis of vasospasm in 73% of cases (95% CI, 63% to 81%), but the diagnostic accuracy of this combination of tests was suboptimal for the prediction of cerebral infarction occurrence (sensitivity, 0.72; specificity, 0.68; positive predictive value, 0.67; negative predictive value, 0.72). Location of the cerebral infarction on delayed CT was predicted by neurological symptoms in 74%, by aneurysm location in 77%, and by angiographic vasospasm in 67%. Conclusions - Evidence of vasospasm on TCD and angiogram is predictive of cerebral infarction on CT scan but sensitivity and specificity are suboptimal. Cerebral infarction location cannot be predicted in one quarter to one third of patients by any of the studied clinical or radiological variables.

AB - Background - Clinical and radiologic predictors of cerebral infarction occurrence and location after aneurysmal subarachnoid hemorrhage have been seldom studied. Methods - We evaluated all patients admitted to our hospital with aneurysmal subarachnoid hemorrhage between 1998 and 2000. Cerebral infarction was defined as a new hypodensity located in a vascular distribution on computed tomography (CT) scan. Results - Fifty-seven of 143 patients (40%) developed a cerebral infarction. On univariate analysis, occurrence of cerebral infarction was associated with a worse World Federation of Neurological Surgeons grade (P=0.01), use of ventriculostomy catheter (P=0.01), preoperative vasospasm (P=0.03), surgical clipping (P=0.02), symptomatic vasospasm (P<0.01), and vasospasm on transcranial Doppler ultrasonography (TCD) or repeat angiogram (P<0.01). On multivariable analysis, only presence of symptoms ascribed to vasospasm (P<0.01) and evidence of vasospasm on TCD or angiogram predicted cerebral infarction (P<0.01). TCD and angiogram agreed on the diagnosis of vasospasm in 73% of cases (95% CI, 63% to 81%), but the diagnostic accuracy of this combination of tests was suboptimal for the prediction of cerebral infarction occurrence (sensitivity, 0.72; specificity, 0.68; positive predictive value, 0.67; negative predictive value, 0.72). Location of the cerebral infarction on delayed CT was predicted by neurological symptoms in 74%, by aneurysm location in 77%, and by angiographic vasospasm in 67%. Conclusions - Evidence of vasospasm on TCD and angiogram is predictive of cerebral infarction on CT scan but sensitivity and specificity are suboptimal. Cerebral infarction location cannot be predicted in one quarter to one third of patients by any of the studied clinical or radiological variables.

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KW - Forecasting

KW - Stroke

KW - Subarachnoid hemorrhage

KW - Ultrasonography, transcranial, Doppler

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