Article
Systematic assessment of early brain injury severity at admission in patients with aneurysmal subarachnoid haemorrhage
Systematische Erfassung des Schweregrades der frühen Hirnschädigung bei Aufnahme von Patienten mit aneurysmatischer Subarachnoidalblutung
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Authors
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Sheri Tuzi
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Beate Kranawetter
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Marielle Sophie Ernst
- Universitätsmedizin Göttingen, Neuroradiologie, Göttingen, Deutschland
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Dorothee Mielke
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Veit Rohde
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
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Vesna Malinova
- Universitätsmedizin Göttingen, Neurochirurgische Klinik, Göttingen, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) has been increasingly recognized as a prognostic factor and a risk factor for delayed cerebral ischemia (DCI). While several clinical and radiological EBI-biomarkers have been already identified, no tool for systematic assessment of EBI-severity has been established so far. The aim of this study was to develop an EBI-grading based on clinical signs and neuroimaging for estimation of EBI-severity at admission.
Methods: An EBI severity score was developed based on imaging parameters (subarachnoid, intraventricular and intraparenchymal blood amount, presence of global cerebral edema (GCE) on initial imaging), and clinical signs (ictal loss of consciousness [LOC]) representative for EBI. The overall intracranial blood amount was semi-quantitatively assessed. One point was added for GCE and LOC, respectively. All points were summed up resulting into a score ranging from 1-5 with higher score indicating more severe EBI. The estimated EBI-severity was correlated with progressive GCE requiring decompressive hemicraniectomy (DHC), DCI-associated infarction, and functional outcome according to modified Rankin scale (mRS) at 3-month-follow up.
Results: A consecutive patient cohort consisting of 324 aSAH-patients with a mean age of 55.9 years was retrospectively analyzed. A high WFNS-grade (4-5) was found in 44% of all patients. The aneurysm was treated by clipping in 53%, and by coiling in 47%. The probability of severe EBI with progressive GCE and persistent coma was 9% for EBI-score 1, 28% for EBI-score 2, 43% for EBI-score 3, 61% for EBI-score 4, and 89% for EBI-score 5. EBI severity score correlated significantly with the need for DHC (r=0.25, p<0.0001), DCI-associated infarction (r=0.30, p<0.0001), and functional outcome (r=0.31, p<0.0001).
Conclusion: EBI-severity score based on clinical and imaging parameters allows an early systematic estimation of EBI-severity. In our study, a higher EBI-score resulted not only into progressive GCE but was also associated with DCI-related infarction, and poor outcome. The EBI-score could be a useful tool for patient selection requiring an early intervention like DHC, with the aim of preventing further brain damage, which needs a prospective validation.
