Cerebral Vasospasm, Delayed Cerebral Ischemia, Subarachnoid Hemorrhage
Conditions
Keywords
CT perfusion, Subarachnoid hemorrhage, Vasospasm, Delayed cerebral ischemia
Brief summary
Prospective evaluation of patients with subarachnoid hemorrhage (SAH) will be done by computed tomography angiography (CTA) and perfusion imaging (CTP) for any correlation between degree of vasospasm and perfusion deficit as well as evaluating the ability of CTP to predict delayed cerebral ischemia.
Detailed description
Cerebral vasospasm is a serious complication of subarachnoid haemorrhage . In the first 2 weeks of SAH, angiographic vasospasm is seen up to 40-70% of patients and causes ischemic deficits in 15-36% of patients. The best clinical indicator of significantly reduced brain perfusion (cerebral blood flow (CBF)\<20 ml per 100 g/min) is the presence of new neurologic deficits. However, clinical symptoms may be vague and mimic other conditions in patients with SAH. CT Perfusion can be used in the evaluation of patients with possible vasospasm after subarachnoid hemorrhage (SAH). It can thus be used to assess cerebral ischemia and infarction as a result of vasospasm after SAH. The presence of cerebral vasospasm identified with transcranial Doppler, digital subtraction angiography, or CT angiography (CTA) is frequently used to confirm DCI. Presence of vasospasm, however, does not prove the presence of ischemia and absence of vasospasm does not rule out. Better diagnostic tests in the acute stage of deterioration, possibly caused by DCI, are therefore needed. In patients with SAH, CTP has recently been shown to be promising for detection of early ischemia.
Interventions
None listed
Sponsors
Assiut University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* All patients presented with subarachnoid haemorrhage
Exclusion criteria
* Patients with abnormal renal functions with creatinine ≥ 2 mg/dl/ * Patients with hypersensitivity to contrast media. * Contraindication to radiation as pregnancy.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cerebral blood flow (CBF) on Admission | 3 days from the attack | Cerebral blood flow (CBF) on Admission in units of ml/100 gram brain tissue/ minute. The measurements will be compared with the outcome of the patient (namely monitoring delayed cerebral ischemia in SAH patients) to test if early CT perfusion could predict the poor outcome in SAH patients. |
| Cerebral blood volume (CBV) on Admission | 3 days from the attack | Cerebral blood volume (CBF) on Admission in units of ml/100 gram brain tissue. |
| Mean transit time (MTT) on Admission | 3 days from the attack | Mean transit time (MTT) on Admission in units of seconds. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation of vasospasm to perfusion abnormality using Comparing between CT angiography and CT perfusion in patients with subarachnoid hemorrhage | 4-14 days from the attack | Evaluating results of CT angiography and CT perfusion in patients for Correlating vasospasm and perfusion abnormality. Results will be dichotomous; positive and negative, then tested by cross tabulation. |
| Hunt and Hess scale | 3 days from the attack | Hunt and Hess clinical scale was performed for every patient. Grades are as the following: Grade 1: Asymptomatic or mild headache Grade 2: Cranial nerve palsy or moderate to severe headache/nuchal rigidity Grade 3: Mild focal deficit, lethargy, or confusion Grade 4: Stupor and/or hemiparesis Grade 5: Deep coma, decerebrate posturing, moribund appearance |
| Fisher scale | 3 days from the attack | Fisher scale quantifies the amount of SAH as the following: 1. None evident 2. Less than 1 mm thick 3. More than 1 mm thick 4. Diffuse or none with intraventricular hemorrhage or parenchymal extension |
Countries
Egypt
Outcome results
None listed