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Impaired Cerebral Autoregulation Is Associated With Vasospasm and Delayed Cerebral Ischemia in Subarachnoid Hemorrhage
- Publication Year :
- 2014
-
Abstract
- Background and Purpose— Cerebral autoregulation may be impaired in the early days after subarachnoid hemorrhage (SAH). The purpose of this study was to examine the relationship between cerebral autoregulation and angiographic vasospasm (aVSP) and radiographic delayed cerebral ischemia (DCI) in patients with SAH. Methods— Sixty-eight patients (54±13 years) with a diagnosis of nontraumatic SAH were studied. Dynamic cerebral autoregulation was assessed using transfer function analysis (phase and gain) of the spontaneous blood pressure and blood flow velocity oscillations on days 2 to 4 post-SAH. aVSP was diagnosed using a 4-vessel conventional angiogram. DCI was diagnosed from CT. Decision tree models were used to identify optimal cut-off points for clinical and physiological predictors of aVSP and DCI. Multivariate logistic regression models were used to develop and validate a risk scoring tool for each outcome. Results— Sixty-two percent of patients developed aVSP, and 19% developed DCI. Patients with aVSP had higher transfer function gain (1.06±0.33 versus 0.89±0.30; P =0.04) and patients with DCI had lower transfer function phase (17.5±39.6 versus 38.3±18.2; P =0.03) compared with those who did not develop either. Multivariable scoring tools using transfer function gain >0.98 and phase Conclusions— Dynamic cerebral autoregulation is impaired in the early days after SAH. Including autoregulation as part of the initial clinical and radiographic assessment may enhance our ability to identify patients at a high risk for developing secondary complications after SAH.
- Subjects :
- Male
Subarachnoid hemorrhage
Ultrasonography, Doppler, Transcranial
Ischemia
Cerebral autoregulation
Risk Assessment
Article
Brain Ischemia
Brain ischemia
Predictive Value of Tests
Risk Factors
medicine
Homeostasis
Humans
Vasospasm, Intracranial
Autoregulation
Aged
Advanced and Specialized Nursing
Models, Statistical
medicine.diagnostic_test
business.industry
Smoking
Age Factors
Vasospasm
Middle Aged
Subarachnoid Hemorrhage
medicine.disease
Cerebral Angiography
Blood pressure
ROC Curve
Anesthesia
Area Under Curve
Cerebrovascular Circulation
Female
Neurology (clinical)
Cardiology and Cardiovascular Medicine
business
Cerebral angiography
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....c50824ad5eafb0368405f2be9489464b