Early Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage Is Associated with Prior Global Cerebral Hypoperfusion

Abstract

Early cerebral infarction (ECI) is an independent factor associated with poor outcome following aneurysmal subarachnoid hemorrhage (aSAH). We aimed to test the association between ECI and prior global impairment of cerebral perfusion. We performed a retrospective cohort study of consecutive patients admitted for aSAH in 2 centers. ECI was defined as any radiological cerebral infarction identified within 3days from the onset of bleeding and not related to aneurysm repair. Global impairment of cerebral perfusion was defined as clinical or transcranial Doppler signs of brain hypoperfusion together with circulatory failure or intracranial hypertension in keeping with guidelines. The association between ECI and prior occurrence of global impairment of cerebral perfusion was tested using binary logistic regression adjusted for confounders identified in the univariate analysis. Seven hundred fifty-three patients with aSAH were included. ECI was observed in 40 patients (5.3%; 95% CI=3.7%-6.9%). Prior global impairment of cerebral perfusion occurred in 90% of them (60% in-hospital) versus in 11% of patients without ECI (P<0.001). In the multivariate analysis, World Federation of Neurological Surgeons grade (OR=2.3, 95% CI= 1.5-3.6, P<0.001), global impairment of cerebral perfusion due to circulatory failure (OR=4.7, 95% CI=1.8-11, P= 0.001), or intracranial hypertension (OR=11.1, 95% CI=3.8-32.3, P<0.001) was an independent risk factor for ECI. Our study demonstrated that ECI is strongly associated with the prior occurrence of global impairment of cerebral perfusion, independent of World Federation of Neurological Surgeons grade. These patients may benefit from more intensive and systematic prevention of impaired cerebral perfusion, particularly in poor-grade patients.