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Updated: Oct 2, 2026
Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI)
Published on: December 16, 2021
Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic
M Shimoda1, M Takeuchi, J Tominaga
1Department of Neurosurgery, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, Japan. m-shimo@is.icc.u-tokai.ac.jp
Objective:
By use of serial magnetic resonance imaging (MRI), we prospectively investigated the incidence of and the risk factors associated with infarction caused by vasospasm with or without a delayed ischemic neurological deficit (DIND) in patients with subarachnoid hemorrhage (SAH).
Methods:
In 125 patients who underwent surgery for early aneurysms, postoperative MRI scans were obtained at four time points. We defined an infarct from vasospasm as a new lesion not present on the initial MRI within 3 days after SAH and therefore not attributable to primary brain damage or surgical complications.
Results:
Overall, symptoms of infarction (i.e., DIND) occurred in 38% of patients (48 of 125); DIND with a new infarct on MRI was evident in 34% (43 patients), whereas 4% (5 patients) showed no new lesion but had a DIND. However, 29 patients (23%) showed a new infarct but no DIND on MRI studies (asymptomatic infarction). Asymptomatic ischemic lesions due to vasospasm tended to involve noneloquent brain areas in the territory of intraparenchymal perforators. Multivariate analysis identified variables associated with symptomatic infarction to be of poor SAH grade, advanced age of the patient, angiographic findings of vasospasm, multiple cortical infarcts on MRI studies consistent with vasospasm, and chronic hydrocephalus.
Conclusion:
Analysis of the data confirmed the occurrence of asymptomatic infarcts due to vasospasm. These infarcts often developed in noneloquent areas representing perforator territory. MRI investigation of vasospastic lesions referable to intraparenchymal vessels such as perforators complements the study of extraparenchymal major vessel vasospasm in patients with SAH by computed tomographic angiography.
Insights
Subarachnoid hemorrhage (SAH) patients can develop asymptomatic brain infarcts from vasospasm, detectable by MRI. Risk factors for symptomatic infarction include poor SAH grade and advanced age.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Subarachnoid hemorrhage (SAH) can lead to delayed ischemic neurological deficits (DIND) due to vasospasm.
- Early detection and risk factor identification for vasospasm-induced infarction are crucial in SAH management.
Purpose of the Study:
- To prospectively investigate the incidence of infarction caused by vasospasm in SAH patients using serial MRI.
- To identify risk factors associated with symptomatic and asymptomatic infarction in SAH patients.
Main Methods:
- Serial MRI scans were performed on 125 patients post-aneurysm surgery at four time points.
- Infarcts were defined as new lesions on MRI not present initially, attributable to vasospasm.
Main Results:
- 38% of patients experienced DIND; 34% had DIND with new infarcts on MRI.
- 23% of patients had asymptomatic infarcts on MRI without DIND.
- Risk factors for symptomatic infarction included poor SAH grade, advanced age, and angiographic vasospasm.
Conclusions:
- Asymptomatic infarcts due to vasospasm occur in SAH patients, often in noneloquent areas.
- MRI is valuable for detecting vasospastic lesions in intraparenchymal vessels, complementing CT angiography.
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