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Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
Published on: August 30, 2020
Vasospasm after spontaneous angiographically negative subarachnoid hemorrhage
Bradley A Gross1, Ning Lin, Kai U Frerichs
1Department of Neurological Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
Acta Neurochirurgica
|May 17, 2012
Summary
Delayed cerebral ischemia (CD-DCI) and vasospasm occur in digital subtraction angiography (DSA)-negative, spontaneous subarachnoid hemorrhage (SAH). Diffuse hemorrhage patterns and higher Hunt-Hess grades are associated risk factors.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Digital subtraction angiography (DSA)-negative, spontaneous subarachnoid hemorrhage (SAH) can lead to vasospasm, delayed infarcts, and clinical deterioration due to delayed cerebral ischemia (CD-DCI).
- These complications are infrequently and inconsistently described in existing literature.
Purpose of the Study:
- To quantify and characterize the rates of vasospasm, delayed infarcts, and CD-DCI in patients with DSA-negative, spontaneous SAH.
- To identify risk factors associated with these complications.
Main Methods:
- A review of 77 patients with DSA-negative, spontaneous SAH was conducted.
- A PubMed search was performed to review existing literature.
- Directly adjusted overall rates of vasospasm, delayed infarcts, and CD-DCI were calculated.
Main Results:
- In the patient cohort, 26% experienced vasospasm, 4% had delayed infarcts, and 4% developed CD-DCI.
- Higher Hunt-Hess grade and diffuse SAH patterns were linked to increased rates of these complications.
- Meta-analysis of 18 studies revealed adjusted overall rates of 16.3% for vasospasm, 3.4% for delayed infarcts, and 6.8% for CD-DCI.
Conclusions:
- Vasospasm, delayed infarcts, and CD-DCI occur in DSA-negative spontaneous SAH, though less frequently than in other SAH types.
- These conditions may necessitate endovascular therapy.
- Diffuse hemorrhage patterns and higher Hunt-Hess grades are identified as significant risk factors.
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