Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Duration of Intracranial Pressure Increase after Aneurysmal Subarachnoid Hemorrhage: Prognostic Factors and Association with the Outcome

Author(s): Pikria Ketelauri*, Meltem Gümüs, Hanah Hadice Gull, Maryam Said, Laurel Rauschenbach, Thiemo Florin Dinger, Mehdi Chihi, Marvin Darkwah Oppong, Yahya Ahmadipour, Philipp Dammann, Karsten Henning Wrede, Ulrich Sure and Ramazan Jabbarli

Volume 21, Issue 3, 2024

Published on: 18 June, 2024

Page: [253 - 262] Pages: 10

DOI: 10.2174/0115672026312548240610104504

Price: $65

Abstract

Objective: A rupture of the intracranial aneurysm is frequently complicated, with an increase of intracranial pressure (ICP) requiring conservative and/or surgical treatment. We analyzed the risk factors related to the duration of pathologic ICP increase and the relationship between ICP burden and the outcome of subarachnoid hemorrhage (SAH).

Methods: Consecutive cases with aneurysmal SAH treated at our institution between 01/2003 and 06/2016 were eligible for this study. Different admission variables were evaluated to predict the duration of ICP increase >20 mmHg in univariate and multivariate analyses. The association of the ICP course with SAH outcome parameters (risk of cerebral infarction, in-hospital mortality, and unfavorable outcome at 6 months defined as modified Rankin scale >3) was adjusted for major outcome-relevant confounders.

Results: Of 820 SAH patients, 378 individuals (46.1%) developed at least one ICP increase requiring conservative and/or surgical management after aneurysm treatment (mean duration: 1.76 days, range: 1 - 14 days). In the multivariable linear regression analysis, patients’ age (unstandardized coefficient [UC]=-0.02, p <0.0001), World Federation of Neurosurgical Societies (WFNS) grade 4-5 at admission (UC=0.71, p <0.004), regular medication with the angiotensinconverting enzyme (ACE) inhibitors (UC=-0.61, p =0.01), and presence of intracerebral hemorrhage (UC=0.59, p =0.002) were associated with the duration of ICP increase. In turn, patients with longer ICP elevations were at higher risk for cerebral infarction (adjusted odds ratio [aOR]=1.32 per-day-increase, p <0.0001), in-hospital mortality (aOR=1.30, p <0.0001) and unfavorable outcome (aOR=1.43, p <0.0001). SAH patients who underwent primary decompressive craniectomy (DC) showed shorter periods of ICP increase than patients with a secondary decompression (mean: 2.8 vs 4.9 days, p <0.0001).

Conclusion: The duration of ICP increase after aneurysm rupture is a strong outcome predictor and is related to younger age and higher initial severity of SAH. Further analysis of the factors impacting the course of ICP after SAH is essential for the optimization of ICP management and outcome improvement.

Keywords: Aneurysmal subarachnoid hemorrhage, intracranial pressure increase, prognostic factors, cerebral infarction, aneurysm rupture, prognosis

[1]
Bederson JB, Connolly ES Jr, Batjer HH, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40(3): 994-1025.
[http://dx.doi.org/10.1161/STROKEAHA.108.191395] [PMID: 19164800]
[2]
Kundra S, Mahendru V, Gupta V, Choudhary A. Principles of neuroanesthesia in aneurysmal subarachnoid hemorrhage. J Anaesthesiol Clin Pharmacol 2014; 30(3): 328-37.
[http://dx.doi.org/10.4103/0970-9185.137261] [PMID: 25190938]
[3]
Long B, Koyfman A, Runyon MS. Subarachnoid Hemorrhage. Emerg Med Clin North Am 2017; 35(4): 803-24.
[http://dx.doi.org/10.1016/j.emc.2017.07.001] [PMID: 28987430]
[4]
Heuer GG, Smith MJ, Elliott JP, Winn HR, Leroux PD. Relationship between intracranial pressure and other clinical variables in patients with aneurysmal subarachnoid hemorrhage. J Neurosurg 2004; 101(3): 408-16.
[http://dx.doi.org/10.3171/jns.2004.101.3.0408] [PMID: 15352597]
[5]
Cossu G, Messerer M, Stocchetti N, Levivier M, Daniel RT, Oddo M. Intracranial pressure and outcome in critically ill patients with aneurysmal subarachnoid hemorrhage: A systematic review. Minerva Anestesiol 2016; 82(6): 684-96.
[PMID: 27045637]
[6]
Baggiani M, Graziano F, Rebora P, et al. Intracranial pressure monitoring practice, treatment, and effect on outcome in aneurysmal subarachnoid hemorrhage. Neurocrit Care 2023; 38(3): 741-51.
[http://dx.doi.org/10.1007/s12028-022-01651-8] [PMID: 36471182]
[7]
Addis A, Baggiani M, Citerio G. Intracranial pressure monitoring and management in aneurysmal subarachnoid hemorrhage. Neurocrit Care 2023; 39(1): 59-69.
[http://dx.doi.org/10.1007/s12028-023-01752-y] [PMID: 37280411]
[8]
Nagel A, Graetz D, Schink T, et al. Relevance of intracranial hypertension for cerebral metabolism in aneurysmal subarachnoid hemorrhage. J Neurosurg 2009; 111(1): 94-101.
[http://dx.doi.org/10.3171/2009.1.JNS08587] [PMID: 19284237]
[9]
Said M, Odensass S, Gümüs M, et al. Comparing radiographic scores for prediction of complications and outcome of aneurysmal subarachnoid hemorrhage: Which performs best? Eur J Neurol 2023; 30(3): 659-70.
[http://dx.doi.org/10.1111/ene.15634] [PMID: 36371646]
[10]
Kramer AH. Critical ICP in subarachnoid hemorrhage: How high and how long? Neurocrit Care 2021; 34(3): 714-6.
[http://dx.doi.org/10.1007/s12028-021-01205-4] [PMID: 33655454]
[11]
Mak CHK, Lu YY, Wong GKC. Review and recommendations on management of refractory raised intracranial pressure in aneurysmal subarachnoid hemorrhage. Vasc Health Risk Manag 2013; 9: 353-9.
[PMID: 23874101]
[12]
Rinkel GJE, Feigin VL, Algra A, van Gijn J. Circulatory volume expansion therapy for aneurysmal subarachnoid haemorrhage. Cochrane Libr 2004; 2004(4): CD000483.
[http://dx.doi.org/10.1002/14651858.CD000483.pub2] [PMID: 15494997]
[13]
Molyneux AJ, Kerr RS. The future management of subarachnoid haemorrhage. J Neuroradiol 2002; 29(2): 74-5.
[14]
Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. VI. Indications for intracranial pressure monitoring. J Neurotrauma 2007; 24 (Suppl. 1): S-37-44.
[http://dx.doi.org/10.1089/neu.2007.9990] [PMID: 17511544]
[15]
Aiolfi A, Benjamin E, Khor D, Inaba K, Lam L, Demetriades D. Brain trauma foundation guidelines for intracranial pressure monitoring: Compliance and effect on outcome. World J Surg 2017; 41(6): 1543-9.
[http://dx.doi.org/10.1007/s00268-017-3898-6] [PMID: 28188356]
[16]
Mayberg MR, Batjer HH, Dacey R, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 1994; 25(11): 2315-28.
[http://dx.doi.org/10.1161/01.STR.25.11.2315] [PMID: 7974568]
[17]
van Gijn J, Rinkel GJE. Subarachnoid haemorrhage: Diagnosis, causes and management. Brain 2001; 124(2): 249-78.
[http://dx.doi.org/10.1093/brain/124.2.249] [PMID: 11157554]
[18]
Jabbarli R, Oppong MD, Dammann P, et al. Time is brain! analysis of 245 cases with decompressive craniectomy due to subarachnoid hemorrhage. World Neurosurg 2017; 98: 689-694.e2.
[http://dx.doi.org/10.1016/j.wneu.2016.12.012] [PMID: 27993743]
[19]
Teasdale GM, Drake CG, Hunt W, et al. A universal subarachnoid hemorrhage scale: Report of a committee of the World Federation of Neurosurgical Societies. J Neurol Neurosurg Psychiatry 1988; 51(11): 1457.
[http://dx.doi.org/10.1136/jnnp.51.11.1457] [PMID: 3236024]
[20]
Fisher CM, Roberson GH, Ojemann RG. Cerebral vasospasm with ruptured saccular aneurysm-the clinical manifestations. Neurosurgery 1977; 1(3): 245-8.
[http://dx.doi.org/10.1227/00006123-197711000-00004] [PMID: 615969]
[21]
Graeb DA, Robertson WD, Lapointe JS, Nugent RA, Harrison PB. Computed tomographic diagnosis of intraventricular hemorrhage. Etiology and prognosis. Radiology 1982; 143(1): 91-6.
[http://dx.doi.org/10.1148/radiology.143.1.6977795] [PMID: 6977795]
[22]
Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke 1996; 27(8): 1304-5.
[http://dx.doi.org/10.1161/01.STR.27.8.1304] [PMID: 8711791]
[23]
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19(5): 604-7.
[http://dx.doi.org/10.1161/01.STR.19.5.604] [PMID: 3363593]
[24]
Ryttlefors M, Howells T, Nilsson P, Ronne-Engström E, Enblad P. Secondary insults in subarachnoid hemorrhage: occurrence and impact on outcome and clinical deterioration. Neurosurgery 2007; 61(4): 704-15.
[http://dx.doi.org/10.1227/01.NEU.0000298898.38979.E3] [PMID: 17986931]
[25]
Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al. Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the American Heart Association. Stroke 2012; 43(6): 1711-37.
[http://dx.doi.org/10.1161/STR.0b013e3182587839] [PMID: 22556195]
[26]
Veldeman M, Weiss M, Daleiden L, et al. Decompressive hemicraniectomy after aneurysmal subarachnoid hemorrhage—justifiable in light of long-term outcome? Acta Neurochir 2022; 164(7): 1815-26.
[http://dx.doi.org/10.1007/s00701-022-05250-6] [PMID: 35597877]
[27]
Ohbuchi H, Hagiwara S, Arai N, Yoneyama T, Takahashi Y, Inazuka M. Optimal timing and safety of the external ventricular drainage in patients with high-grade aneurysmal subarachnoid hemorrhage treated with endovascular coiling. J Clin Neurosci 2021; 88: 63-9.
[http://dx.doi.org/10.1016/j.jocn.2021.03.003]
[28]
Ohbuchi H, Kasuya H, Hagiwara S, et al. Appropriate treatment within 13 hours after onset may improve outcome in patients with high-grade aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg 2023; 230: 107776.
[http://dx.doi.org/10.1016/j.clineuro.2023.107776] [PMID: 37229951]
[29]
Sahuquillo J, Arikan F. Decompressive craniectomy for the treatment of refractory high intracranial pressure in traumatic brain injury. Cochrane Libr 2006; (1): CD003983.
[http://dx.doi.org/10.1002/14651858.CD003983.pub2] [PMID: 16437469]
[30]
Schirmer CM, Hoit DA, Malek AM. Decompressive hemicraniectomy for the treatment of intractable intracranial hypertension after aneurysmal subarachnoid hemorrhage. Stroke 2007; 38(3): 987-92.
[http://dx.doi.org/10.1161/01.STR.0000257962.58269.e2] [PMID: 17272765]
[31]
Jabbarli R, Darkwah Oppong M, Roelz R, et al. The pressure score to predict decompressive craniectomy after aneurysmal subarachnoid haemorrhage. Brain Commun 2020; 2(2): fcaa134.
[http://dx.doi.org/10.1093/braincomms/fcaa134] [PMID: 33215084]
[32]
Zoerle T, Lombardo A, Colombo A, et al. Intracranial pressure after subarachnoid hemorrhage. Crit Care Med 2015; 43(1): 168-76.
[http://dx.doi.org/10.1097/CCM.0000000000000670] [PMID: 25318385]
[33]
Czosnyka M, Balestreri M, Steiner L, et al. Age, intracranial pressure, autoregulation, and outcome after brain trauma. J Neurosurg 2005; 102(3): 450-4.
[http://dx.doi.org/10.3171/jns.2005.102.3.0450] [PMID: 15796378]
[34]
Stocchetti N, Carbonara M, Citerio G, et al. Severe traumatic brain injury: Targeted management in the intensive care unit. Lancet Neurol 2017; 16(6): 452-64.
[http://dx.doi.org/10.1016/S1474-4422(17)30118-7] [PMID: 28504109]
[35]
Lee SH, Oh CW, Han JH, et al. The effect of brain atrophy on outcome after a large cerebral infarction. J Neurol Neurosurg Psychiatry 2010; 81(12): 1316-21.
[http://dx.doi.org/10.1136/jnnp.2009.197335] [PMID: 20650914]
[36]
Wagner M, Jurcoane A, Volz S, et al. Age-related changes of cerebral autoregulation: new insights with quantitative T2′-mapping and pulsed arterial spin-labeling MR imaging. AJNR Am J Neuroradiol 2012; 33(11): 2081-7.
[http://dx.doi.org/10.3174/ajnr.A3138] [PMID: 22700750]
[37]
Wang X, Chen J, Mao Q, Liu Y, You C. Relationship between intracranial pressure and aneurysmal subarachnoid hemorrhage grades. J Neurol Sci 2014; 346(1-2): 284-7.
[http://dx.doi.org/10.1016/j.jns.2014.09.011] [PMID: 25245175]
[38]
Ravishankar N, Nuoman R, Amuluru K, et al. Management strategies for intracranial pressure crises in subarachnoid hemorrhage. J Intensive Care Med 2020; 35(3): 211-8.
[http://dx.doi.org/10.1177/0885066618813073] [PMID: 30514150]
[39]
Dodd WS, Laurent D, Dumont AS, et al. Pathophysiology of delayed cerebral ischemia after subarachnoid hemorrhage: A review. J Am Heart Assoc 2021; 10(15): e021845.
[http://dx.doi.org/10.1161/JAHA.121.021845] [PMID: 34325514]
[40]
Whittle C, Hollingworth MA, Dulhanty L, Patel HC. What are the predictors of delayed cerebral ischaemia (DCI) after aneurysmal subarachnoid haemorrhage? An up-to-date systematic review. Acta Neurochir 2023; 165(12): 3643-50.
[http://dx.doi.org/10.1007/s00701-023-05864-4] [PMID: 37968365]
[41]
Raatikainen E. Delayed cerebral ischemia and blood coagulation changes after aneurysmal subarachnoid hemorrhage. Doctoral program in medicine and life sciences, dissertation, tampere university, 2023.
[42]
Darkwah Oppong M, Gümüs M, Pierscianek D, et al. Aneurysm rebleeding before therapy: A predictable disaster? J Neurosurg 2019; 131(5): 1473-80.
[http://dx.doi.org/10.3171/2018.7.JNS181119]
[43]
Otani N, Takasato Y, Masaoka H, et al. Surgical outcome following decompressive craniectomy for poor-grade aneurysmal subarachnoid hemorrhage in patients with associated massive intracerebral or Sylvian hematomas. Cerebrovasc Dis 2008; 26(6): 612-7.
[http://dx.doi.org/10.1159/000165115] [PMID: 18946217]
[44]
Osborn JW, Fink GD. Region‐specific changes in sympathetic nerve activity in angiotensin II–salt hypertension in the rat. Exp Physiol 2010; 95(1): 61-8.
[http://dx.doi.org/10.1113/expphysiol.2008.046326] [PMID: 19717492]
[45]
Wilms H, Rosenstiel P, Unger T, Deuschl G, Lucius R. Neuroprotection with angiotensin receptor antagonists: A review of the evidence and potential mechanisms. Am J Cardiovasc Drug 2005; 5(4): 245-53.
[http://dx.doi.org/10.2165/00129784-200505040-00004]
[46]
Muller F, Lartaud I, Bray L, et al. Chronic treatment with the angiotensin I converting enzyme inhibitor, perindopril, restores the lower limit of autoregulation of cerebral blood flow in the awake renovascular hypertensive rat. J Hypertens 1990; 8(11): 1037-42.
[http://dx.doi.org/10.1097/00004872-199011000-00010] [PMID: 1963186]
[47]
Manschot SM, Biessels GJ, Cameron NE, et al. Angiotensin converting enzyme inhibition partially prevents deficits in water maze performance, hippocampal synaptic plasticity and cerebral blood flow in streptozotocin-diabetic rats. Brain Res 2003; 966(2): 274-82.
[http://dx.doi.org/10.1016/S0006-8993(02)04211-7] [PMID: 12618350]
[48]
Hatazawa J, Shimosegawa E, Osaki Y, et al. Long-term angiotensin-converting enzyme inhibitor perindopril therapy improves cerebral perfusion reserve in patients with previous minor stroke. Stroke 2004; 35(9): 2117-22.
[http://dx.doi.org/10.1161/01.STR.0000136034.86144.e9] [PMID: 15256675]
[49]
Panahpour H, Dehghani GA, Bohlooli S. Enalapril attenuates ischaemic brain oedema and protects the blood–brain barrier in rats via an anti‐oxidant action. Clin Exp Pharmacol Physiol 2014; 41(3): 220-6.
[http://dx.doi.org/10.1111/1440-1681.12210] [PMID: 24471927]

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy