Abstract 2777: Delayed Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage is Predictive of Neurological and Cognitive Outcomes, but not Quality of Life Outcomes

Abstract

Background and purpose: In an attempt to resolve the inconsistency of results in aneurysmal subarachnoid hemorrhage clinical trials to reduce delayed cerebral ischemia and improve clinical outcome, an international panel has suggested future clinical trials to target the surrogate outcome of delayed cerebral infarction (dCI), based on studies on the prognostic value of dCI in neurological outcome. Few studies examined the prognostic values of dCI in cognitive and quality of life outcomes, which were considered to be more sensitive to the long term burden. Methods: Episode and 3-month outcome data of a 4-center Hong Kong prospective observational study are analyzed. dCI is defined as new cerebral infarction identified on computed tomography after exclusion of procedure-related infarctions. Delayed ischemic neurological deficit (DIND) is defined as clinical deterioration presumably caused by delayed cerebral ischemia after exclusion of other potential causes of clinical deterioration. Outcomes include modified Rankin Scale, Lawton Instrumental Activity of Daily Living, in-patient mortality, Montreal Cognitive Assessment, Mini-Mental State Examination, Stroke-specific Quality of Life Scale, Short Form-36. Relationships of delayed cerebral infarction or delayed ischemic neurological deficit with outcomes are examined using nonparametric Kendall’s rank correlation (tau). The study is registered in ClinicalTrials.gov, U.S. National Institute of Health ( NCT01038193 ). Results: One hundred and fifty-eight patients are included in the current study. Age (mean+/-SD) are 54+/-11 years. Admission WFNS grade is I to II, III to IV, and V in 68%, 18%, and 14% of patients respectively. Fisher CT grade is III in 47% of patients while intraventricular hemorrhage and/or intracerebral hematoma are present in 52% of patients. dCI and/or DIND are present in 26% of patients. dCI is significantly correlated with modified Rankin Scale, in-patient mortality, Montreal Cognitive Assessment, and Mini-Mental State Examination, but not Stroke-specific Quality of Life Scale and Short Form-36. Presence of DIND is significantly correlated with modified Rankin Scale and Lawton Instrumental Activity of Daily Living, but not with cognitive and quality of life outcomes. Conclusion: Delayed cerebral infarction can act as surrogate outcome for both neurological and cognitive outcomes. However, the lack of correlations to both generic and disease-specific quality of life measures suggest that some significant outcome determinants of aneurysmal subarachnoid hemorrhage, such as neuropsychiatric outcomes, cannot be captured by dCI alone and should be further investigated. Moreover, delayed cerebral infarction after aneurysmal subarachnoid hemorrhage and ischemic stroke may carry different pathophysiological meanings.