Artikel
Transcranial doppler monitoring, vasospasm, and new ischemic brain lesions after acute subarachnoid hemorrhage: an age-related time to event analysis
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Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Vasospasm and secondary ischemic intracerebral lesions after acute subarachnoid hemorrhage (SAH) are associated with high morbidity. The study aim was a time to event analysis of vasospasm and ischemic brain lesions after acute SAH in different age groups.
Methods: The study included 117 patients with the diagnosis of acute SAH. Patients' data was collected out of a prospective observational database. TCD was measured daily in all patients. Time from SAH onset to vasospasm and ischemic brain lesions were calculated in different age groups. Outcome was determined with the Glasgow-Outcome-Scale.
Results: Mild vasospasm, severe vasospasm, and new ischemic brain lesions were found in 66.7%, 13.7%, and 23.9%, respectively. Severe vasospasm occurred earlier than mild vasospasm (4.94 ± 3.2 days vs. 7.19 ± 4.4 days; P = 0.022). Duration of vasospasm was longer in patients with new ischemic brain lesions (12.4 ± 5.7 days vs. 9.5 ± 6.5 days; P = 0.044). The incidence of severe vasospasm was higher in patients with new ischemic brain lesions (56.3% vs. 18.8%; P = 0.001). In the age group < 50 years, a higher proportion of patients with new ischemic brain lesions was observed (32.7% vs. 16.1%, P = 0.036). Time from vasospasm onset to new ischemic brain lesions was lower in patients < 50 years 9.6 ± 6.5 days vs. 6.2 ± 2.7 days; P = 0.065). In contrast, the rate of unfavorable outcome was higher in patients with an age ≥ 50 years (P = 0.076).
Conclusions: After acute SAH, a higher incidence rate of severe vasospasm and new ischemic brain lesions was observed in patients < 50 years. In our data severe vasospasm was a predictor of new ischemic brain lesions and should be treated aggressively especially in patients < 50 years.