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Systematic assessment of early brain injury severity at admission with aneurysmal subarachnoid hemorrhage

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Title: Systematic assessment of early brain injury severity at admission with aneurysmal subarachnoid hemorrhage
Authors: Sheri Tuzi, Beate Kranawetter, Dorothee Mielke, Veit Rohde, Vesna Malinova
Contributors: Tuzi, Sheri, Kranawetter, Beate, Mielke, Dorothee, Rohde, Veit, Malinova, Vesna
Source: Neurosurg Rev
Publisher Information: Springer Science and Business Media LLC, 2023.
Publication Year: 2023
Subject Terms: Male, Adult, ddc:610, Decompressive Craniectomy, Research, Brain Edema, Subarachnoid Hemorrhage, Middle Aged, Severity of Illness Index, Brain Edema/diagnostic imaging [MeSH], Brain Edema/etiology [MeSH], Female [MeSH], Brain Injuries/complications [MeSH], Aged [MeSH], Adult [MeSH], Early brain injury, Humans [MeSH], Severity of Illness Index [MeSH], Retrospective Studies [MeSH], Middle Aged [MeSH], Subarachnoid Hemorrhage/complications [MeSH], Brain Ischemia/complications [MeSH], Male [MeSH], Brain imaging, Subarachnoid Hemorrhage/surgery [MeSH], Subarachnoid hemorrhage, Decompressive Craniectomy/methods [MeSH], Brain Ischemia, Brain Injuries, Humans, Female, Aged, Retrospective Studies
Description: Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) has been increasingly recognized as a risk factor for delayed cerebral ischemia (DCI). While several clinical and radiological EBI biomarkers have been identified, no tool for systematic assessment of EBI severity has been established so far. This study aimed to develop an EBI grading system based on clinical signs and neuroimaging for estimation of EBI severity at admission. This is a retrospective observational study assessing imaging parameters (intracranial blood amount, global cerebral edema (GCE)), and clinical signs (persistent loss of consciousness [LOC]) representative for EBI. The intracranial blood amount was semi-quantitatively assessed. One point was added for GCE and LOC, respectively. All points were summed up resulting in an EBI grading ranging from 1 to 5. The estimated EBI severity was correlated with progressive GCE requiring decompressive hemicraniectomy (DHC), DCI-associated infarction, and outcome according to the modified Rankin scale (mRS) at 3-month-follow up. A consecutive cohort including 324 aSAH-patients with a mean age of 55.9 years, was analyzed. The probability of developing progressive GCE was 9% for EBI grade 1, 28% for EBI grade 2, 43% for EBI grade 3, 61% for EBI grade 4, and 89% for EBI grade 5. The EBI grading correlated significantly with the need for DHC (r = 0.25, p r = 0.30, p r = 0.31, p
Document Type: Article
Other literature type
File Description: application/pdf
Language: English
ISSN: 1437-2320
DOI: 10.1007/s10143-024-03081-w
DOI: 10.1101/2023.10.17.23297185
Access URL: https://pubmed.ncbi.nlm.nih.gov/39514015
https://resolver.sub.uni-goettingen.de/purl?gro-2/146901
https://opus.bibliothek.uni-augsburg.de/opus4/frontdoor/index/index/docId/119366
https://nbn-resolving.org/urn:nbn:de:bvb:384-opus4-1193664
https://doi.org/10.1007/s10143-024-03081-w
https://opus.bibliothek.uni-augsburg.de/opus4/files/119366/s10143-024-03081-w.pdf
https://repository.publisso.de/resource/frl:6512378
Rights: CC BY
Accession Number: edsair.doi.dedup.....e93ea357ff8fc8801a05e615e0cfae1d
Database: OpenAIRE
Description
Abstract:Early brain injury (EBI) after aneurysmal subarachnoid hemorrhage (aSAH) has been increasingly recognized as a risk factor for delayed cerebral ischemia (DCI). While several clinical and radiological EBI biomarkers have been identified, no tool for systematic assessment of EBI severity has been established so far. This study aimed to develop an EBI grading system based on clinical signs and neuroimaging for estimation of EBI severity at admission. This is a retrospective observational study assessing imaging parameters (intracranial blood amount, global cerebral edema (GCE)), and clinical signs (persistent loss of consciousness [LOC]) representative for EBI. The intracranial blood amount was semi-quantitatively assessed. One point was added for GCE and LOC, respectively. All points were summed up resulting in an EBI grading ranging from 1 to 5. The estimated EBI severity was correlated with progressive GCE requiring decompressive hemicraniectomy (DHC), DCI-associated infarction, and outcome according to the modified Rankin scale (mRS) at 3-month-follow up. A consecutive cohort including 324 aSAH-patients with a mean age of 55.9 years, was analyzed. The probability of developing progressive GCE was 9% for EBI grade 1, 28% for EBI grade 2, 43% for EBI grade 3, 61% for EBI grade 4, and 89% for EBI grade 5. The EBI grading correlated significantly with the need for DHC (r = 0.25, p r = 0.30, p r = 0.31, p
ISSN:14372320
DOI:10.1007/s10143-024-03081-w