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. 2011 Oct;1(4):165-71.
doi: 10.1177/1941875211413134.

Is asymptomatic vasospasm associated with poor outcome in subarachnoid hemorrhage?

Julius Gene S Latorre  1 , Yahia Lodi, Ziad El-Zammar, Ashok Devasenapathy
Affiliations

Is asymptomatic vasospasm associated with poor outcome in subarachnoid hemorrhage?

Julius Gene S Latorre et al. Neurohospitalist. 2011 Oct.

Abstract

Background: Vasospasm occurs in up to 70% of aneurysmal subarachnoid hemorrhage (aSAH), but only half becomes symptomatic. It is unclear whether asymptomatic vasospasm (AV) detected by noninvasive testing affects outcome. Prophylactic hemodilutional, hypertensive, and hypervolemic (HHH) therapy is widely used but the benefit remains unproven. We aim to determine whether AV increases the risk of poor outcome and whether HHH is safe.

Methods: A total of 175 consecutive patients with aSAH without clinical vasospasm were included. Patients with sonographic (transcranial doppler) or radiologic (computed tomography [CT] Angiography) vasospasm were assigned to AV group, while those without were assigned to no vasospasm (NV) group. Logistic regression was used to determine the association between AV and HHH on poor outcome, defined as modified Rankin scale (mRS) >3 at discharge or 3 to 6 months' follow-up.

Results: In all, 106 patients had NV and 25 received HHH. A total of 69 patients had AV and 54 received HHH. Asymptomatic vasospasm compared to NV was not associated with poor outcome (odds ratio [OR] 2.6, 95% confidence interval [CI]: 0.75-8.9; P = .1). Hemodilutional, hypertensive, and hypervolemic use in patients with AV did not improve the outcome (OR 0.16, 95%CI: 0.009-2.84; P = .2). In patients with NV, HHH use showed trend toward poor outcome after multivariable adjustment (OR 12.6, 95%CI: 1.08-146.5 P = .04).

Conclusion: Asymptomatic vasospasm does not appear to be associated with poor outcome in aSAH. Hemodilutional, hypertensive, and hypervolemic therapy in AV was not associated with improved outcome and may be harmful to patients who do not have vasospasm. Further research is needed to validate this finding.

Keywords: cerebrovascular disorders; clinical specialty; intracranial; neurocritical care; subarachnoid hemorrhage; vasospasm.

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Conflict of interest statement

The author(s) declared no conflicts of interest with respect to the authorship and/or publication of this article.

References

    1. Dorsch NW. Cerebral arterial spasm–a clinical review. Br J Neurosurg. 1995;9(3):403–412 - PubMed
    1. Diringer MN. Management of aneurysmal subarachnoid hemorrhage. Crit Care Med. 2009;37(2):432–440 - PMC - PubMed
    1. Hunt MA, Bhardwaj A. Caveats for triple-h therapy in the management of vasospasm after aneurysmal subarachnoid hemorrhage. Crit Care Med. 2007;35(8):1985–1986 - PubMed
    1. Shimoda M, Takeuchi M, Tominaga J, Oda S, Kumasaka A, Tsugane R. Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic resonance imaging. Neurosurgery. 2001;49(6):1341–1348 discussion 1348–1350 - PubMed
    1. Schmidt JM, Wartenberg KE, Fernandez A, et al. Frequency and clinical impact of asymptomatic cerebral infarction due to vasospasm after subarachnoid hemorrhage. J Neurosurg. 2008;109(6):1052–1059 - PubMed