Early Cerebral Circulatory Disturbance in Patients Suffering Subarachnoid Hemorrhage Prior to the Delayed Cerebral Vasospasm Stage: Xenon Computed Tomography and Perfusion Computed Tomography Study

DOI Web Site PubMed 被引用文献2件 参考文献50件
  • HONDA Mitsuru
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • SASE Shigeru
    Anzai Medical Co., Ltd.
  • YOKOTA Kyosuke
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • ICHIBAYASHI Ryo
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • YOSHIHARA Katsunori
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • SAKATA Yoshihito
    Department of Critical Care Center, Toho University Medical Center Omori Hospital
  • MASUDA Hiroyuki
    Department of Neurosurgery, Toho University Medical Center Omori Hospital
  • UEKUSA Hiroyuki
    Department of Neurosurgery, Toho University Medical Center Omori Hospital
  • SEIKI Yoshikatsu
    Department of Neurosurgery, Toho University Medical Center Omori Hospital
  • KISHI Taichi
    Department of Education Planning and Development, School of Medicine, Faculty of Medicine, Toho University

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Subarachnoid hemorrhage (SAH) causes dynamic changes in cerebral blood flow (CBF), and results in delayed ischemia due to vasospasm, and early perfusion deficits before delayed cerebral vasospasm (CVS). The present study examined the severity of cerebral circulatory disturbance during the early phase before delayed CVS and whether it can be used to predict patient outcome. A total of 94 patients with SAH underwent simultaneous xenon computed tomography (CT) and perfusion CT to evaluate cerebral circulation on Days 1-3. Cerebral blood flow (CBF) was measured using xenon CT and the mean transit time (MTT) using perfusion CT and calculated cerebral blood volume (CBV). Outcome was evaluated with the Glasgow Outcome Scale (good recovery [GR], moderate disability [MD], severe disability [SD], vegetative state [VS], or death [D]). Hunt and Hess (HH) grade II patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. HH grade III patients displayed significantly higher CBF and lower MTT than HH grade IV and V patients. Patients with favorable outcome (GR or MD) had significantly higher CBF and lower MTT than those with unfavorable outcome (SD, VS, or D). Discriminant analysis of these parameters could predict patient outcome with a probability of 74.5%. Higher HH grade on admission was associated with decreased CBF and CBV and prolonged MTT. CBF reduction and MTT prolongation before the onset of delayed CVS might influence the clinical outcome of SAH. These parameters are helpful for evaluating the severity of SAH and predicting the outcomes of SAH patients.<br>

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