Heterogeneity of cerebral perfusion 1 week after haemorrhage is an independent predictor of clinical outcome in patients with aneurysmal subarachnoid haemorrhage

被引:16
|
作者
Mustonen, T. [1 ,2 ]
Koivisto, T. [3 ]
Vanninen, R. [2 ]
Hanninen, T. [4 ]
Vapalahti, M. [3 ]
Hernesniemi, J. [3 ]
Kuikka, J. T. [1 ,5 ]
Vanninen, E. [1 ]
机构
[1] Univ Kuopio, Dept Clin Physiol & Nucl Med, Kuopio Univ Hosp, FIN-70211 Kuopio, Finland
[2] Univ Kuopio, Dept Clin Radiol, Kuopio Univ Hosp, FIN-70211 Kuopio, Finland
[3] Univ Kuopio, Dept Neurosurg, Kuopio Univ Hosp, FIN-70211 Kuopio, Finland
[4] Kuopio Univ Hosp, Dept Neurol, SF-70210 Kuopio, Finland
[5] Niuvanniemi Hosp, Kuopio, Finland
来源
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY | 2008年 / 79卷 / 10期
关键词
D O I
10.1136/jnnp.2007.142851
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and purpose: Aneurysmal subarachnoid haemorrhage (aSAH) can be associated with acute global and regional decrease in cerebral perfusion. Furthermore, cerebral vasospasm may lead to development of delayed ischaemic deficits. The aim of the study was to find out whether cerebral perfusion heterogeneity, an indicator of cerebral microvascular function and autoregulation, measured by single-photon emission tomography (SPET), is able to predict the long-term clinical outcome of aSAH. Methods: The perfusion SPET data of 55 patients with aSAH were analysed by dividing the brain into 384 regions of interest. Spatial perfusion heterogeneity was assessed by calculating the relative dispersions (RD, coefficient of variation) from the SPETs performed before treatment (RD1) and 1 week after early surgical or endovascular treatment of the ruptured aneurysm (RD2). Both RDs were compared to the clinical outcome (Glasgow Outcome Scale, GOS), neuropsychological test scores and late ischaemic findings in MRI 1 year after SAH. Results: High RD2 (OR 1.96; 95% CI 1.18-3.26; p = 0.009) and poor clinical condition (Hunt and Hess grade) on admission (OR 6.60; 95% CI 1.78-24.52; p = 0.005) proved to be independent predictors of poor or moderate clinical outcome (GOS 1-4). RD2 was higher in patients with ischaemic findings in 12-month MRI than in those without ischaemic findings (p = 0.008). RD2 also correlated with neuropsychological outcome 1 year after aSAH. Conclusions: Perfusion heterogeneity is an independent predictor of the clinical outcome of aSAH and may thus be a valuable measure in the assessment of the disease.
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收藏
页码:1128 / 1133
页数:6
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