Journal article
Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage
Acta neurochirurgica. Supplement, Vol.127, pp.149-153
2020
DOI: 10.1007/978-3-030-04615-6_22
PMID: 31407076
Abstract
Early identification of vasospasm prior to symptom onset would allow prevention of delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH). Dynamic cerebral autoregulation (DCA) is a noninvasive means of assessing cerebral blood flow regulation by determining independence of low-frequency temporal oscillations of systemic blood pressure (BP) and cerebral blood flow velocities (CBFV).
Eight SAH patients underwent prospectively a median of 7 DCA assessments consisting of continuous measurements of BCFV and BP. Transfer function analysis was applied to calculate average phase shift (PS) in low (0.07-0.2 Hz) frequency range for each hemisphere as continuous measure of DCA. Lower PS indicated poorer regulatory response. DCI was defined as a 2-point decrease in Glasgow Coma Score and/or infarction on CT.
Three subjects developed symptomatic vasospasm with median time-to-DCI of 9 days. DCI was significantly associated with lower PS over the entire recording period (Wald = 4.28; p = 0.039). Additionally, there was a significant change in PS over different recording periods after adjusting for DCI (Wald = 15.66; p = 0.001); particularly, a significantly lower mean PS day 3-5 after bleed (14.22 vs 27.51; p = 0.05).
DCA might be useful for early detection of symptomatic vasospasm. A larger cohort study of SAH patients is currently underway.
Details
- Title: Subtitle
- Changes on Dynamic Cerebral Autoregulation Are Associated with Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage
- Creators
- S Ortega-Gutierrez - Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USA. santy-ortega@uiowa.eduE A Samaniego - Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USAA Reccius - Department of Critical Care, Clinica Alemana, Universidad del Desarrollo, Santiago, ChileA Huang - Department of Neurology, Columbia University, New York, NY, USAB Zheng-Lin - Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology, University of Iowa Hospitals and Clinics, Iowa, IA, USAA Masukar - Department of Neurology, Columbia University, New York, NY, USAR S Marshall - Department of Neurology, Columbia University, New York, NY, USAN H Petersen - Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
- Resource Type
- Journal article
- Publication Details
- Acta neurochirurgica. Supplement, Vol.127, pp.149-153
- Publisher
- Austria
- DOI
- 10.1007/978-3-030-04615-6_22
- PMID
- 31407076
- eISBN
- 303004615X; 9783030046156
- ISSN
- 0065-1419
- eISSN
- 2197-8395
- Language
- English
- Date published
- 2020
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984070533902771
Metrics
34 Record Views