Title:Early Cerebral Infarction Following Aneurysmal Subarachnoid Hemorrhage: Frequency, Risk Factors, Patterns, and Prognosis
Volume: 10
Issue: 4
Author(s): Chao Fu, Weidong Yu, Libo Sun, Dongyuan Li and Conghai Zhao
Affiliation:
Keywords:
Cerebral infarction, Intracranial aneurysm, Prognosis, Risk factors, Stroke, Subarachnoid hemorrhage.
Abstract: Early cerebral infarction (ECI) following aneurysmal subarachnoid hemorrhage (aSAH) remains poorly
understood. This study aims to determine the frequency and risk factors of this special episode, as well as to assess the
relationship between its patterns and outcome. We retrospectively enrolled 243 patients who underwent aneurysm
treatment within 60 hours of SAH. ECI was defined as one or more new hypodense abnormalities on computed
tomography within 3 days after SAH, rather than lesions attributable to edema, retraction effect, and ventricular drain
placement. Risk factors were tested by multivariate analysis. The infarct was classified by an established grading system
(single or multiple, cortical or deep or combined). Poor outcome was defined as the Glasgow Outcome Score of severe
disability or worse. Sixty-five patients (26.7%) had early infarction. Acute hydrocephalus (odds ratio [OR] 6.67; 95%
confidence interval [CI] 1.59-27.95), admission plasma glucose level (OR 1.42 per mmol/L; 95% CI 1.16-1.73), and
treatment modality (OR 16.27; 95% CI 4.05-65.28) were independent predictors of ECI. The pattern was single cortical in
19 patients (29.2%), single deep in 9 (13.8%), multiple cortical in 8 (12.3%), multiple deep in 14 (21.5%), and multiple
combined in 15 (23.1%). ECI was associated with delayed cerebral infarction (DCI) (P = 0.002) and poor outcome (P <
0.001). Multiple combined infarction was related to poor outcome (P = 0.001). In summary, the occurrence of ECI, which
is associated with surgical treatment, acute hydrocephalus and high admission plasma glucose, may potentially predict
DCI and unfavorable outcome. Further studies are warranted to reveal the underlying mechanisms of this event and
thereby minimize it.