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Early vs. Delayed Cerebral Infarction Following Aneurysm Repair after Subarachnoid Hemorrhage.
MedLine Citation:
PMID:  23787882     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Cerebral infarction is a major contributor to poor outcome after subarachnoid hemorrhage (SAH). While usually considered a complication of delayed cerebral ischemia (DCI), infarcts may also occur early, in relation to initial brain injury or aneurysm-securing procedures.
OBJECTIVE:: We analyzed the relative frequency and volume of early vs. delayed infarcts after SAH and their relationship to hospital outcome.
METHODS:: Retrospective review of consecutive patients admitted with aneurysmal SAH over 4-years who had follow-up brain imaging ≥7 days after admission. Imaging 24-48-hours after aneurysm-securing procedures was reviewed to classify infarcts seen on final imaging as early or delayed. Infarct volumes were measured by perimeter tracing and infarct burden calculated for each patient.
RESULTS:: 205 of 250 eligible patients had follow-up imaging. Infarcts were present in 61. Of these, 29 had early infarcts, 16 had delayed infarcts, and 5 had both early and delayed infarcts. 11 patients with infarcts lacked post-procedure CT; these were presumptively classified as late infarcts. Early and delayed infarcts contributed equally to infarct burden. Early infarcts were associated with aneurysm clipping (OR 4.2, 95% CI 1.8-9.5 compared to coiling), while delayed infarcts were almost always seen in association with angiographic vasospasm (OR 3.3, 1.5-7.3). Patients with early as well as late infarcts, especially those with infarct burden over 30 cm had worse hospital discharge disposition.
CONCLUSION:: Early infarction occurs frequently after SAH and contributes as much as DCI to infarct burden and hospital outcome. Efforts to better understand and modify contributors to early infarction appear warranted.
Authors:
Abhay Kumar; Robert Brown; Rajat Dhar; Tomoko Sampson; Colin P Derdeyn; Christopher J Moran; Michael N Diringer
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-19
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-6-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Departments of Neurology 2Neurological Surgery 3Radiology , Washington University School of Medicine, St. Louis, MO.
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