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Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage: Location, Distribution Patterns, Infarct Load,

Michael Veldeman1, Tobias Rossmann1, Roel Haeren1

  • 1From the Department of Neurosurgery (M.V., L.V.V., C.C., T.P.S., A.H., H.C.), RWTH Aachen University Hospital, Germany; Department of Neurosurgery (T.R.), Neuromed Campus, Kepler University Hospital, Linz, Austria; Department of Neurosurgery (R.H.), Maastricht University, Maastricht University Medical Center+, the Netherlands; Department of Neurosurgery (M. Weiss), Kantonsspital Aarau, Switzerland; Department of Neurosurgery (J.O.S., M.K., J.S., M.N., R.R.), University of Helsinki and Helsinki University Hospital; Division of Anesthesiology (J.J.V., T.L.), Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Finland; and Department of Neuroradiology (M. Wiesmann), RWTH Aachen University Hospital, Germany.

Neurology
|July 1, 2024
PubMed

Insights

Delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) significantly increases the risk of poor outcomes. Specific infarct locations, particularly in the left MCA and anterior cerebral artery territories, are strongly linked to unfavorable 1-year results.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Delayed cerebral ischemia (DCI) is a major cause of poor outcomes following aneurysmal subarachnoid hemorrhage (SAH).
  • DCI can lead to irreversible brain injury and infarction, significantly impacting patient prognosis.
  • Understanding the relationship between infarct characteristics and clinical outcomes is crucial for effective management.

Purpose of the Study:

  • To investigate the association between the location, distribution, and volume of DCI-related infarcts and clinical outcomes in SAH patients.
  • To identify specific anatomical regions of infarction that predict unfavorable 1-year outcomes.

Main Methods:

  • A cohort of SAH patients from two university hospitals (2006-2020) was analyzed.
  • Infarct size was quantified by volume (mL), and distribution was assessed across 14 regions using a modified ASPECTS model.
  • One-year clinical outcome was evaluated using the Glasgow Outcome Scale (GOS), dichotomized into favorable (GOS 4-5) and unfavorable (GOS 1-3).

Main Results:

  • Of 1,190 SAH patients, 155 (13%) developed DCI-related infarction.
  • DCI-related infarction was significantly associated with unfavorable 1-year outcome (OR 4.89).
  • Infarction in the left middle cerebral artery and left/right anterior cerebral artery territories, as well as specific ASPECTS regions (right M3, right A2), were independently linked to poor outcomes.

Conclusions:

  • DCI-related infarction increases the odds of unfavorable 1-year outcome by approximately five-fold.
  • The location and distribution of ischemic lesions in specific brain regions are critical determinants of long-term neurological deficits after SAH.
Abstract

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