|Predictive value of initial clinical status, intracranial pressure and transcranial Doppler pulsatility after subarachnoid haemorrhage.|
|PMID: 17460816 Owner: NLM Status: MEDLINE|
|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.
|M Soehle; D A Chatfield; M Czosnyka; P J Kirkpatrick|
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|Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2007-04-26|
|Title: Acta neurochirurgica Volume: 149 ISSN: 0942-0940 ISO Abbreviation: Acta Neurochir (Wien) Publication Date: 2007 Jun|
|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|
|Languages: eng Pagination: 575-83 Citation Subset: IM|
|APA/MLA Format Download EndNote Download BibTex|
Activities of Daily Living
Blood Pressure / physiology*
Brain / blood supply*
Glasgow Coma Scale*
Glasgow Outcome Scale*
Homeostasis / physiology
Hyperemia / physiopathology, ultrasonography
Intracranial Aneurysm / mortality, psychology, therapy, ultrasonography*
Intracranial Pressure / physiology*
Middle Cerebral Artery / physiopathology, ultrasonography
Pulsatile Flow / physiology*
Quality of Life / psychology
Subarachnoid Hemorrhage / mortality, physiopathology, psychology, ultrasonography*
Ultrasonography, Doppler, Pulsed*
Ultrasonography, Doppler, Transcranial*
Vascular Resistance / physiology*
|G9439390//Medical Research Council|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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