Retrospective review of previous minor leak before major subarachnoid hemorrhage diagnosed by MRI as a predictor of occurrence of symptomatic delayed cerebral ischemia

• Published in: Journal of neurosurgery Vol. 128; no. 2; pp. 499 - 505
• Main Authors: Oda, Shinri, Shimoda, Masami, Hirayama, Akihiro, Imai, Masaaki, Komatsu, Fuminari, Shigematsu, Hideaki, Nishiyama, Jun, Hotta, Kazuko, Matsumae, Mitsunori
• Format: Journal Article
• Language: English
• Published: United States 01-02-2018
• Subjects: ICH = intracerebral hemorrhage; magnetic resonance imaging; SAH = subarachnoid hemorrhage; WFNS = World Federation of Neurosurgical Societies; minor leak; delayed cerebral ischemia; DWI = diffusion weighted imaging; vascular disorders; T1WI = T1-weighted imaging; BHSB = bright hyperintense subarachnoid blood; subarachnoid hemorrhage; mRS = modified Rankin Scale; sDCI = symptomatic delayed cerebral ischemia
• ISSN: 0022-3085; 1933-0693
• DOI: 10.3171/2016.10.jns161964

OBJECTIVE This study attempted to determine whether a previous minor leak correlated with the occurrence of symptomatic delayed cerebral ischemia (sDCI). METHODS The authors retrospectively evaluated sDCI-related clinical features and findings from MRI, including T1-weighted imaging (T1WI)-FLAIR mismatch at the time of admission, in 151 patients admitted with subarachnoid hemorrhage (SAH) within 48 hours of ictus. RESULTS The overall incidence of sDCI was 23% (35 of 151 patients). In all subjects, multivariate analysis revealed that World Federation of Neurosurgical Societies Grades II-V, age 70 years or older, presence of rebleeding after admission, a previous minor leak before the major SAH attack as diagnosed by T1WI-FLAIR mismatch, acute infarction on diffusion-weighted imaging, and CT SAH score were significantly associated with occurrence of sDCI. In patients with no previous minor leak before major SAH as diagnosed by T1WI-FLAIR mismatch, the incidence of sDCI was only 7% (7 of 97 patients). CONCLUSIONS A previous minor leak before major SAH as diagnosed by T1WI-FLAIR mismatch represents an important sDCI-related factor. When the analysis was restricted to patients with true acute SAH without a previous minor leak diagnosed by T1WI-FLAIR mismatch, the incidence of sDCI was extremely low.