gms | German Medical Science

71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

The value of cranial MRI during the early treatment course in patients with poor-grade aneurysmal subarachnoid haemorrhage

Der Nutzen der kraniellen MR Bildgebung während des frühen Therapieverlaufs bei Patienten mit poor-grade aneurysmatischer Subarachnoidalblutung

Meeting Abstract

  • presenting/speaker Simon Brandecker - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Alexis Hadjiathanasiou - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Lorena Maria Schenk - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Patrick Schuss - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Hartmut Vatter - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland
  • Erdem Güresir - Universitätsklinikum Bonn, Klinik und Poliklinik für Neurochirurgie, Bonn, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocP089

doi: 10.3205/20dgnc376, urn:nbn:de:0183-20dgnc3765

Published: June 26, 2020

© 2020 Brandecker et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: The aim of this study was to present the value of cranial MRI during the early treatment course in patients with poor-grade (WFNS grade IV and V) aneurysmal subarachnoid hemorrhage (aSAH) in view of decisions for therapy limitation resulting from this.

Methods: Between 10/2012 and 04/2019 a total number of 146 patients with poor-grade aSAH (WFNS grade IV and V) were treated at our institution. Patient data were prospectively entered into a computerized database. Patients underwent cranial MRI in the first 10 days, when there was no trend in clinical improvement. We retrospectively analysed the data of radiological MRI findings in these after SAH patients and analysed the decisions for therapy limitation resulting from this. Outcome was analysed according to modified Rankin Scale (mRS) and dichotomized into favourable (mRS 0-4) versus unfavourable (mRS 5-6) outcome after 6 months.

Results: Of the 146 patients with poor-grade aSAH treated at our institution between 10/2012 and 04/2019, 33 patients (22.6 %) underwent cranial MRI in the first 10 days after SAH for evaluating general prognosis. In 10 patients (30.3 % of patients with cMRI) a decisionforf therapy limitation was made because of the radiological findings, which had been brain stem infarction (20.0 %), mesencephalic infarction (30.0 %), hemispheric infarction (20.0 %), multi-infarction (20.0 %) and disseminated micro bleeding / septic embolism (10.0 %). In patients with an early cMRI and without limitation of therapy a favourable outcome could be achieved in 21.7 %.

Conclusion: In a relevant number of patients receiving a cMRI in order to evaluate general prognosis, a decision for therapy limitation was made following the radiological findings in cMRI. Furthermore, in patients with an early cMRI and without limitation of therapy, a relevant number of patients were able to achieve a favourable outcome. Therefore cranial MRI in the early treatment course of patients with poor-grade aSAH seems to be important and should not be omitted in thiese severely ill patiens.