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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
Published on: August 30, 2020
Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage
Richard E Temes1, Elena Tessitore, J Michael Schmidt
1Neurological Intensive Care Unit, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Neurocritical Care
|October 15, 2010
Summary
Left ventricular dysfunction after subarachnoid hemorrhage (SAH) increases risks for cerebral infarction and other complications. However, with intensive care, it does not impact short-term survival or functional outcomes in SAH patients.
Area of Science:
- Cardiology
- Neurology
- Critical Care Medicine
Background:
- Neurogenic stunned myocardium (NSM) following subarachnoid hemorrhage (SAH) is recognized, but its clinical impact is not fully understood.
- Investigating the relationship between left ventricular (LV) dysfunction, cerebral vasospasm, and patient outcomes after SAH is crucial.
Purpose of the Study:
- To determine the influence of LV dysfunction and cerebral vasospasm on cerebral infarction.
- To assess the impact of LV dysfunction on serious cardiovascular events and functional outcomes post-SAH.
Main Methods:
- Analysis of 119 SAH patients with echocardiograms and transcranial Doppler (TCD) data, excluding those with prior cardiac disease.
- LV dysfunction defined as ejection fraction <40%; infarction from vasospasm adjudicated via clinical and imaging data.
- Functional outcomes measured using the modified Rankin Scale (mRS) at 15 and 90 days.
Main Results:
- 11% of patients exhibited LV dysfunction, associated with younger age, hydrocephalus, and specific ventricular filling patterns.
- Patients with LV dysfunction had higher rates of vasospasm-induced infarction, hypotension, and pulmonary edema.
- No significant association found between LV dysfunction and 14-day outcomes after adjusting for prognostic variables.
Conclusions:
- LV dysfunction post-SAH elevates the risk of cerebral infarction from vasospasm, hypotension, and pulmonary edema.
- Aggressive intensive care unit (ICU) support mitigates the effect of LV dysfunction on short-term survival and functional outcomes.
- Antihypertensive medication may offer cardioprotection and reduce catecholamine-mediated injury following SAH.
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