Brain Injury Visible on Early MRI After Subarachnoid Hemorrhage Might Predict Neurological Impairment and Functional Outcome

• Published in: Neurocritical care 2015-02, Vol.22 (1), p.74-81
• Main Authors: De Marchis, Gian Marco, Filippi, Christopher G., Guo, Xiaotao, Pugin, Deborah, Gaffney, Christopher D., Dangayach, Neha S., Suwatcharangkoon, Sureerat, Falo, M. Cristina, Schmidt, J. Michael, Agarwal, Sachin, Connolly, E. Sander, Claassen, Jan, Zhao, Binsheng, Mayer, Stephan A.
• Format: Article
• Language: English
• Subjects: Aged; Algorithms; Aneurysms; Brain Injuries - etiology; Brain Injuries - pathology; Brain Injuries - therapy; Coma; Critical Care Medicine; Edema; Female; Follow-Up Studies; Hemorrhage; Humans; Hydrocephalus; Intensive; Internal Medicine; Ischemia; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Original Article; Outcome Assessment (Health Care); Severity of Illness Index; Software; Stroke; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - physiopathology; Subarachnoid Hemorrhage - therapy; Surgeons; Time Factors; Traumatic brain injury
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-014-0008-6

Background In subarachnoid hemorrhage (SAH), brain injury visible within 48 h of onset may impact on admission neurological disability and 3-month functional outcome. With volumetric MRI, we measured the volume of brain injury visible after SAH, and assessed the association with admission clinical grade and 3-month functional outcome. Methods Retrospective cohort study conducted in the Neurocritical Care Division, Columbia University Medical Center, New York, USA. On brain MRI acquired within 48 h of SAH-onset and before aneurysm-securing ( n  = 27), two blinded readers measured DWI and FLAIR-lesion volumes using semi-automated, computer segmentation software. Results Compared to post-resuscitation Hunt–Hess grade 1–3 (70 %), high-grade patients (30 %) had higher lesion volumes on DWI (34 ml [IQR: 0–64] vs. 2 ml [IQR: 0.5–7], P  = 0.02) and on FLAIR (81 ml [IQR: 24–127] vs. 3 ml [IQR: 0–27], P  = 0.02). On DWI, each 10 ml increase in lesion volume was associated with a 101 %-increase in the odds of presenting with 1 grade more in the Hunt–Hess scale (aOR 2.01, 95 % CI 1.10–3.68, P  = 0.02), but was not significantly associated with 3-month outcome. On FLAIR, each 10 ml increase in lesion volume was associated with 34 % higher odds of a 1-point increase on the Hunt–Hess scale (aOR 1.34, 95 % CI 1.06–1.68, P  = 0.01) and 139 % higher odds of a 1-point increase on the 3-month mRS (aOR 2.39, 95 % CI 1.13–5.07, P  = 0.02). Conclusion The volume of brain injury visible on DWI and FLAIR within 48 h after SAH is proportional to neurological impairment on admission. Moreover, FLAIR-imaging implicates chronic brain injury—predating SAH—as potentially relevant cause of poor functional outcome.