Document Detail


Predictive value of initial clinical status, intracranial pressure and transcranial Doppler pulsatility after subarachnoid haemorrhage.
MedLine Citation:
PMID:  17460816     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We examined the predictive value of initial clinical status, mean arterial blood pressure (MABP), intracranial pressure (ICP) and transcranial Doppler (TCD)-derived pulsatility and resistance indices for outcome and quality of life one year following aneurysmal subarachnoid haemorrhage (SAH).
METHOD: Neuromonitoring was performed in 29 patients following clipping or coiling of an aneurysm. Mean arterial blood pressure was measured in the radial artery and intracranial pressure was assessed via a closed external ventricular drainage. Based on transcranial Doppler-recordings of the middle cerebral artery, Gosling's pulsatility (PI) and Pourcelot's resistance (RI) index were calculated. Glasgow outcome score (GOS) and short form-36 (SF-36) scores were determined one year after SAH.
FINDINGS: An unfavourable outcome (GOS 1-3) was observed in 34% of patients and correlated significantly (p < 0.05) with a poor initial clinical status, as determined by Glasgow Coma Scale (r = 0.55), Hunt and Hess (r = -0.62), World Federation of Neurosurgical Societies (WFNS) (r = -0.48) and Fisher (r = -0.58) score. Poor outcome was significantly associated with high mean arterial blood pressure (r = -0.44) and intracranial pressure (r = -0.48) as well as increased pulsatility (r = -0.46) and resistance (r = -0.43) indices. Hunt and Hess grade > or = 4 (OR 12.4, 5-95% CI: 1.9-82.3), mean arterial blood pressure > 95 mmHg (19.5, 2.9-132.3), Gosling's pulsatility >0.8 (6.5, 1.6-27.1) and Pourcelot's resistance >0.57 (15.4, 2.3-103.4) were predictive for unfavourable outcome in logistic regression, however TCD-diagnosed vasospasm was not. Except for mental health, significantly reduced scores were observed in all short form-36 domains. Initial clinical status correlated significantly with the physical functioning, role physical, bodily pain, social functioning and physical component summary of short form-36.
CONCLUSIONS: Mortality and morbidity following SAH remains high, especially in poor-grade patients. Outcome is mainly correlated with initial clinical status, mean arterial blood pressure, intracranial pressure, pulsatility and resistance indices. Those factors seem to be stronger than the influence of vasospasm.
Authors:
M Soehle; D A Chatfield; M Czosnyka; P J Kirkpatrick
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-04-26
Journal Detail:
Title:  Acta neurochirurgica     Volume:  149     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2007 Jun 
Date Detail:
Created Date:  2007-05-28     Completed Date:  2008-01-18     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  575-83     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living / psychology
Adult
Aged
Blood Pressure / physiology*
Brain / blood supply*
Female
Glasgow Coma Scale*
Glasgow Outcome Scale*
Homeostasis / physiology
Humans
Hyperemia / physiopathology,  ultrasonography
Intensive Care
Intracranial Aneurysm / mortality,  psychology,  therapy,  ultrasonography*
Intracranial Pressure / physiology*
Male
Middle Aged
Middle Cerebral Artery / physiopathology,  ultrasonography
Prognosis
Prospective Studies
Pulsatile Flow / physiology*
Quality of Life / psychology
Subarachnoid Hemorrhage / mortality,  physiopathology,  psychology,  ultrasonography*
Survival Rate
Ultrasonography, Doppler, Pulsed*
Ultrasonography, Doppler, Transcranial*
Vascular Resistance / physiology*
Grant Support
ID/Acronym/Agency:
G9439390//Medical Research Council

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