Predictive value of initial clinical status, intracranial pressure and transcranial Doppler pulsatility after subarachnoid haemorrhage
- 26 April 2007
- journal article
- Published by Springer Science and Business Media LLC in Acta Neurochirurgica
- Vol. 149 (6), 575-583
- https://doi.org/10.1007/s00701-007-1149-6
Abstract
Background. We examined the predictive value of initial clinical status, mean arterial blood pressure (MABP), intracranial pressure (ICP) and transcranial Doppler (TCD)-derived pulsatility and resistance indices for outcome and quality of life one year following aneurysmal subarachnoid haemorrhage (SAH). Method. Neuromonitoring was performed in 29 patients following clipping or coiling of an aneurysm. Mean arterial blood pressure was measured in the radial artery and intracranial pressure was assessed via a closed external ventricular drainage. Based on transcranial Doppler-recordings of the middle cerebral artery, Gosling’s pulsatility (PI) and Pourcelot’s resistance (RI) index were calculated. Glasgow outcome score (GOS) and short form-36 (SF-36) scores were determined one year after SAH. Findings. An unfavourable outcome (GOS 1–3) was observed in 34% of patients and correlated significantly (p < 0.05) with a poor initial clinical status, as determined by Glasgow Coma Scale (r = 0.55), Hunt and Hess (r = −0.62), World Federation of Neurosurgical Societies (WFNS) (r = −0.48) and Fisher (r = −0.58) score. Poor outcome was significantly associated with high mean arterial blood pressure (r = −0.44) and intracranial pressure (r = −0.48) as well as increased pulsatility (r = −0.46) and resistance (r = −0.43) indices. Hunt and Hess grade ≥4 (OR 12.4, 5–95% CI: 1.9–82.3), mean arterial blood pressure > 95 mmHg (19.5, 2.9–132.3), Gosling’s pulsatility >0.8 (6.5, 1.6–27.1) and Pourcelot’s resistance >0.57 (15.4, 2.3–103.4) were predictive for unfavourable outcome in logistic regression, however TCD-diagnosed vasospasm was not. Except for mental health, significantly reduced scores were observed in all short form-36 domains. Initial clinical status correlated significantly with the physical functioning, role physical, bodily pain, social functioning and physical component summary of short form-36. Conclusions. Mortality and morbidity following SAH remains high, especially in poor-grade patients. Outcome is mainly correlated with initial clinical status, mean arterial blood pressure, intracranial pressure, pulsatility and resistance indices. Those factors seem to be stronger than the influence of vasospasm.Keywords
This publication has 33 references indexed in Scilit:
- Critical Closing Pressure in Subarachnoid HemorrhageStroke, 2004
- Global Cerebral Edema After Subarachnoid HemorrhageStroke, 2002
- Transcranial Doppler Versus Angiography in Patients With Vasospasm due to a Ruptured Cerebral AneurysmStroke, 2001
- Outcomes of Early Endovascular Versus Surgical Treatment of Ruptured Cerebral AneurysmsStroke, 2000
- Factors implicated in deaths from subarachnoid haemorrhage: are they avoidable?British Journal of Neurosurgery, 1998
- Relationship between transcranial Doppler-determined pulsatility index and cerebrovascular resistance: an experimental studyJournal of Neurosurgery, 1996
- A new therapy of post-trauma brain oedema based on haemodynamic principles for brain volume regulationIntensive Care Medicine, 1994
- Validating the SF-36 health survey questionnaire: new outcome measure for primary care.BMJ, 1992
- Validity of cerebral arterial blood flow calculations from velocity measurements.Stroke, 1989
- Treatment of Ischemic Deficits from Vasospasm with Intravascular Volume Expansion and Induced Arterial HypertensionNeurosurgery, 1982