Clinical, transcranial Doppler ultrasound, radiological features and, prognostic significance of delayed cerebral ischemia

Abstract

Objective: We aimed to investigate the profiles and prognostic values of delayed cerebral ischemia (DCI) and delayed cerebral infarction.

Methods: IMASH (Intravenous Magnesium Sulphate for Aneurysmal Subarachnoid Hemorrhage) was registered at http://www.strokecenter.org/trials , and http://www.ClinicalTrials.gov (NCT00124150). Data of 327 patients were retrieved for logistic regression analyses.

Results: Seventy-one (22%) patients developed DCI, and 35 (11%) patients developed delayed cerebral infarction. Only 18 (25%) patients with DCI and 7/35 (20%) patients with delayed cerebral infarction had mean middle cerebral artery velocities (transcranial Doppler ultrasound) over 120 cm/s. Regarding the prognostic significance of the components of DCI, delayed cerebral infarction predicted unfavorable outcome in terms of Extended Glasgow Outcome Scale (OR 3.1, 95% [CI] 1.3-7.8), poor outcome in terms of modified Rankin Scale (odds ratio [OR] 3.0, 95% confidence interval CI 1.2-7.7), and dependent activity of daily living in terms of Barthel Index (OR 3.6, 95% CI 1.4-9.2) at 6 months, after adjustments for other prognostic factors. On the other hand, clinical deterioration predicted inpatient mortality (OR 8.8, 95% CI 1.6-48.8) after adjustments for other prognostic factors.

Conclusions: Delayed cerebral ischemia and delayed cerebral infarction carried different prognostic values in aneurysmal subarachnoid hemorrhage.