rss
J Neurol Neurosurg Psychiatry 2008;79:1128-1133 doi:10.1136/jnnp.2007.142851
  • Research paper

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

  1. T Mustonen1,2,
  2. T Koivisto3,
  3. R Vanninen2,
  4. T Hänninen4,
  5. M Vapalahti3,
  6. J Hernesniemi3,
  7. J T Kuikka1,5,
  8. E Vanninen1
  1. 1
    Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, University of Kuopio, Kuopio, Finland
  2. 2
    Department of Clinical Radiology, Kuopio University Hospital, University of Kuopio, Kuopio, Finland
  3. 3
    Department of Neurosurgery, Kuopio University Hospital, University of Kuopio, Kuopio, Finland
  4. 4
    Department of Neurology, Kuopio University Hospital, Kuopio, Finland
  5. 5
    Niuvanniemi Hospital, Kuopio, Finland
  1. Dr Esko Vanninen, Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, POB 1777, FIN-70211 Kuopio, Finland; esko.vanninen{at}kuh.fi
  • Received 22 December 2007
  • Revised 19 February 2008
  • Accepted 23 February 2008
  • Published Online First 20 March 2008

Abstract

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.

Footnotes

  • Competing interests: None.

This Article

  1. Abstract
  2. Full text
  3. PDF
  4. All versions of this article:
    1. jnnp.2007.142851v1
    2. 79/10/1128 most recent

Responses

  1. Submit a response
  2. No responses published

Register for free content

The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.

BMJ Careers - Latest neurology and neurosurgery jobs