Subarachnoid Hemorrhage Volume Research Articles

Predicting vasospasm risk using first presentation aneurysmal subarachnoid hemorrhage volume: A semi-automated CT image segmentation analysis using ITK-SNAP.

Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is a significant complication associated with poor neurological outcomes. We present a novel, semi-automated pipeline, implemented in the open-source medical imaging analysis software ITK-SNAP, to segment subarachnoid blood volume from initial CT head (CTH) scans and use this to predict future radiological vasospasm. 42 patients were admitted between February 2020 and December 2021 to our tertiary neurosciences center, and whose initial referral CTH scan was used for this retrospective cohort study. Blood load was segmented using a semi-automated random forest classifier and active contour evolution implemented in ITK-SNAP. Clinical data were extracted from electronic healthcare records in order to fit models aimed at predicting radiological vasospasm risk. Semi-automated segmentations demonstrated excellent agreement with manual, expert-derived volumes (mean Dice coefficient = 0.92). Total normalized blood volume, extracted from CTH images at first presentation, was significantly associated with greater odds of later radiological vasospasm, increasing by approximately 7% for each additional cm3 of blood (OR = 1.069, 95% CI: 1.021-1.120; p < .005). Greater blood volume was also significantly associated with vasospasm of a higher Lindegaard ratio, of longer duration, and a greater number of discrete episodes. Total blood volume predicted radiological vasospasm with a greater accuracy as compared to the modified Fisher scale (AUC = 0.86 vs 0.70), and was of independent predictive value. Semi-automated methods provide a plausible pipeline for the segmentation of blood from CT head images in aSAH, and total blood volume is a robust, extendable predictor of radiological vasospasm, outperforming the modified Fisher scale. Greater subarachnoid blood volume significantly increases the odds of subsequent vasospasm, its time course and its severity.

Circular RNA hsa_circ_0000690 as a potential biomarker for diagnosis and prognosis of intracranial aneurysm: Closely relating to the volume of hemorrhage.

This study aimed to explore circular RNA (circRNA) hsa_circ_0000690 as a potential biomarker for diagnosis and prognosis of intracranial aneurysm (IA) and its relationship with clinical factors and complications of IA. 216 IA patients admitted to the neurosurgery department of our hospital from January 2019 to December 2020 were selected as the experimental group, and 186 healthy volunteers were selected as the control group. The expression of hsa_circ_0000690 in peripheral blood was detected by quantitative real-time PCR, and its diagnostic value was assessed by receiver operating characteristic curve. Relationship between hsa_circ_0000690 and clinical factors of IA was assessed by chi-square test. Nonparametric test was used in univariate analysis, and regression analysis was used in multivariate analysis. Multivariate Cox proportional hazards regression analysis was used to analyze the survival time. CircRNA hsa_circ_0000690 of IA patients was relatively lower than that in the control group (p<.001). The AUC of hsa_circ_0000690 was 0.752, the specificity was 0.780, and sensitivity was 0.620, with diagnostic threshold of 0.0449. In addition, hsa_circ_0000690 expression was correlated with Glasgow Coma Scale, the volume of subarachnoid hemorrhage, modified Fisher scale, Hunt-Hess levels and surgical type. For hydrocephalus and delayed cerebral ischemia, hsa_circ_0000690 was significant in univariate analysis, but nonsignificant in multivariate analysis. For prognosis, hsa_circ_0000690 was significantly associated with modified Rankin Scales after surgery for 3 months, but not associated with survival time. The expression of hsa_circ_0000690 can act as a diagnostic marker for IA and predict the prognosis of 3 months after operation and is closely related to the volume of hemorrhage.

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI).

The endovascular filament perforation model to mimic subarachnoid hemorrhage (SAH) is a commonly used model - however, the technique can cause a high mortality rate as well as an uncontrollable volume of SAH and other intracranial complications such as stroke or intracranial hemorrhage. In this protocol, a standardized SAH mouse model is presented, induced by endovascular filament perforation, combined with magnetic resonance imaging (MRI) 24 h after operation to ensure the correct bleeding site and exclude other relevant intracranial pathologies. Briefly, C57BL/6J mice are anesthetized with an intraperitoneal ketamine/xylazine (70 mg/16 mg/kg body weight) injection and placed in a supine position. After midline neck incision, the common carotid artery (CCA) and carotid bifurcation are exposed, and a 5-0 non-absorbable monofilament polypropylene suture is inserted in a retrograde fashion into the external carotid artery (ECA) and advanced into the common carotid artery. Then, the filament is invaginated into the internal carotid artery (ICA) and pushed forward to perforate the anterior cerebral artery (ACA). After recovery from surgery, mice undergo a 7.0 T MRI 24 h later. The volume of bleeding can be quantified and graded via postoperative MRI, enabling a robust experimental SAH group with the option to perform further subgroup analyses based on blood quantity.

Importance of CBF measurement to exclude concomitant cerebral infarction in the murine endovascular perforation SAH model

ObjectiveConcomitant cerebral infarction (CI) is could be a potential concern in experimental subarachnoid hemorrhage (SAH) induced by endovascular perforation. We propose a noninvasive method for excluding CI in a murine SAH model by using Laser speckle flow imaging (LSFI). MethodsAn SAH was induced with endovascular perforation (EVP) in male ddY mice. The cerebral blood flow (CBF) was quantitatively measured in the bilateral cerebral cortex was performed by using LSFI at five timepoints (preprocedure, immediately after, and 3 hours, 6 hours, and 24 hours after the procedure). The mice were then euthanized, and the SAH grade and volume of the CI were evaluated. The mice were divided into the SAH group and the SAH + CI group. Differences between the groups were assessed. ResultsForty-eight mice were used in this study. Six were the sham control group. Five SAH mice died within 24 hours after the procedure. A large CI on the ipsilateral side occurred in 15 (40.5%) mice (i.e., SAH + CI group). The remaining 22 (59.5%) mice were classified as the SAH group. The SAH grading score was not significantly different between the groups. The neurological score and CBF of the ipsilateral hemisphere were significantly higher in the SAH group than in the SAH + CI group (neurological score: 12.3 vs. 8, p < 0.01; CBF: 343.1 vs. 205.5; p < 0.01). The cut-off modified neurological score for excluding CI was 8 (area under the curve [AUC]: 0.77) and CBF at 24 hours after the procedure was 279.2 (AUC:0.856). ConclusionsUsing LSFI is less invasive and effectively excludes concomitant CI in experimental SAH. This methodological protocol may ad in improving the quality of the EVP-SAH model.

Correlation between gray matter volume loss followed by aneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage volume

Aneurysmal subarachnoid hemorrhage (SAH) can chronically affect cognitive function, and SAH has been suggested to result in regional brain damage. This study aimed to assess regional structural damage according to initial clinical status including SAH volume. A total of 63 consecutive patients treated with coil embolization for intracranial aneurysms for more than 6months were enrolled. Of these, 35 patients had SAH and 28 patients who were treated for unruptured aneurysms served as controls. Volumetric T1-weighted images were acquired with 1mm isotropic voxel. The SAH volume was measured semi-automatically from the initial brain CT scan. Voxel-based group comparison was conducted to assess regional gray matter volume (GMV) changes. Voxel-based multiple regression was conducted to analyze regional GMV change and SAH volume. The clinical factors (Glasgow Coma Scale (GCS), SAH volume, systolic blood pressure, and serum laboratory findings) associated with regional GMV were also analyzed by using multiple regression. The SAH group had significantly lower GMV in the left hippocampus and higher GMV in the visual cortex than controls (Alphasim-corrected p < 0.05, voxel level of p < 0.001). The GMV of the bilateral hippocampi, thalami, and left medial orbital gyrus was negatively correlated with the initial SAH volume (FDR-corrected p < 0.05). SAH volume and GCS were associated with the hippocampal GMV in multiple regression (p < 0.05). Chronic regional GMV change after SAH was related to the severity of initial clinical status including SAH volume. This finding supports the pathophysiological hypothesis of SAH-induced microstructural brain injury.

Automated segmentation of subarachnoid hemorrhages with convolutional neural networks

Abstract Purpose To investigate the viability of convolutional neural networks (CNNs) for the detection and volumetric segmentation of subarachnoid hemorrhage (SAH) in non-contrast computed tomography (NCCT). Materials and methods We developed and trained a CNN for the SAH segmentation by splitting a set of 302 baseline NCCTs into a training (268) and a validation set (34). Segmentation accuracy was assessed on an additional 473 baseline NCCTs of SAH patients by calculating the intraclass correlation coefficient of the SAH volume and the Dice coefficient of the segmentations. We subsequently evaluated whether the developed SAH segmentation network can be used to discriminate SAH from acute ischemic stroke using 280 scans to optimize the discrimination and 70 scans for testing. Additionally, we tested whether the CNN-based volumetric SAH segmentation can also be used for hemorrhage segmentation in 396 NCCTs of rebleed patients. Results The SAH volume agreement was high with an intraclass correlation coefficient of 0.966. The average Dice coefficient of the volumetric SAH segmentation was 0.63 ± 0.16, which is similar to expert interobserver agreement. The differentiation of SAH from ischemic stroke patients achieved an accuracy of 0.96. Despite the common presence of severe metal artifacts in scans of rebleed patients due to coiling, the CNN-based segmentation appears to be suitable for segmentation of rebleeds as well with comparable accuracy. The average CNN detection and segmentation processing time was 30 s. Conclusion The proposed CNN is fast and accurate in detecting and segmenting SAH in NCCT scans.

Association of Cerebrospinal Fluid Volume with Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Retrospective Volumetric Analysis.

In aneurysmal subarachnoid hemorrhage (SAH), clot volume has been shown to correlate with the development of radiographic vasospasm (VS), while the role of cerebrospinal fluid (CSF) volume remains largely elusive in the literature. We evaluated CSF volume as a potential surrogate for VS in addition to SAH volume in this retrospective series. From a consecutive cohort of aneurysmal SAH (n= 320), cases were included when angiographic evaluation for VS was performed (n= 125). SAH and CSF volumes were volumetrically quantified using an algorithm-assisted segmentation approach on initial computed tomography after ictus. Association with VS was analyzed using regression analysis. Receiver operating characteristic (ROC) curves were used to evaluate predictive accuracy of volumetric measures for VS and to identify cutoffs for risk stratification. Among 125 included cases, angiography showed VS in 101 (VS+), while no VS was observed in 24 (VS-) cases. In volumetric analysis, mean SAH volume was significantly larger (26.8 ± 21.1ml vs. 12.6 ± 12.2ml, p= 0.001), while mean CSF volume was significantly smaller (63.0 ± 31.2ml vs. 85.7 ± 62.8, p= 0.03) in VS+ compared to VS- cases, respectively. The absence of correlation for SAH and CSF volumes (Pearson R - 0.05, p= 0.58) indicated independence of both measures of the subarachnoid compartment, which was a prerequisite for CSF to act as a new surrogate for VS not related to SAH. Regression analysis confirmed an increased risk of VS with increasing SAH (OR 1.06, 95% CI 1.02-1.11, p= 0.006), while CSF had a protective effect toward VS (OR 0.99, 95% CI 0.98-0.99, p= 0.02). SAH/CSF ratio was also associated with VS (OR 1.03, 95% CI 1.01-1.05, p= 0.015). ROC curves suggested cutoffs at 120ml CSF and 20ml SAH for VS stratification. Combination of variables improved stratification accuracy compared to use of SAH alone. This study provides a proof of concept for CSF correlating with angiographic VS after aneurysmal SAH. Quantification of CSF in conjunction with SAH might enhance risk stratification and exhibit advantages over traditional scores. The association of CSF has to be corroborated for delayed cerebral ischemia to further establish CSF as a surrogate parameter.

Treatment Trends and Outcome of Aneurysmal Subarachnoid Hemorrhage by Hospital Volume

Abstract INTRODUCTION With increasing availability of endovascular aneurysm treatment, more patients with aneurysmal subarachnoid hemorrhage (SAH) may be treated at lower-volume centers. In this nationwide observational cohort study, we determine treatment trends over time and their impact on SAH patient outcome. METHODS Using data from the Nationwide Inpatient Sample (NIS, 2005-2015), we identified patients with aneurysmal SAH treated with either endovascular coiling (EC) or surgical clipping (SC). Patients with SAH from other causes, such as trauma or arteriovenous malformations, were excluded. Primary endpoint was in-hospital mortality and was assessed using multivariate logistic regression adjusted for age, comorbidities, and annual hospital SAH volume. Lower volume centers were defined as centers performing 10 or fewer annual SAH treatments. RESULTS Among 105 557 patients with aneurysmal SAH from 2005 to 2015, 68% were female and the median age was 54 [IQR 46-64]. In total, 60% were treated with EC and 40% with SC. Over the time span of the study, the number of patients with SAH remained comparable (8798 vs 9833, 2005 vs 2015), and the number of hospitals treating SAH did not increase. Lower-volume hospitals were more likely to perform SC early in the cohort (32% EC vs 68% SC, 2005-2011) compared to later (72% EC vs 28% SC, 2012-2015). In adjusted logistic regression from data between years 2012 and 2015, we observed a continuous decline in the likelihood of in-hospital mortality with increasing annual SAH treatments, with a significant decrease among hospitals performing 12 or more cases per year (OR 0.74, CI 0.58-0.93, P &lt; .05). CONCLUSION In this observational cohort, we found increasing numbers of patients treated with EC at lower volume centers over time. Increasing annual aneurysmal SAH treatment volume corresponded with decreasing in-hospital mortality.

The Proliferation Capacity of Cultured Neural Stem Cells Promoted by CSF Collected from SAH Patients Correlates to Clinical Outcome

Neurogenesis from endogenous neural stem cells (NSCs) might contribute to functional recovery after stroke based on animal studies; however, the relationship between neurogenesis and post-stroke outcome has rarely been demonstrated in humans. We prospectively collected cerebrospinal fluid (CSF) from 36 patients with subarachnoid hemorrhage (SAH). The CSF was added to the culture medium of the rat NSCs to test the effects on proliferation (proliferation index [PI], percentage of Ki-67 immunoreactive cells). We correlated the PI with functional outcome based on the modified Rankin Scale at 3 months post-SAH. Treatment with the CSF samples collected from SAH patients showed a higher PI compared with those collected from patients with normal pressure hydrocephalus and untreated controls (20.3 ± 8.8 vs. 8.2 ± 5.1 and 7.8 ± 3.0, P < 0.001), indicating proliferation-promoting factors in CSF after SAH. The PI was positively correlated with SAH volume (p = 0.025). For patients with lower SAH volume, patients with favorable outcome had a higher PI than those with poor outcome (20.8 ± 6.9 vs. 14.6 ± 4.3, p = 0.047). Using multivariable logistic regression analysis, the PI was a positive determinant for favorable outcome (odds ratio, 1.17; 95% confidence interval, 1.00 to 1.36) that more proliferation-promoting factors in CSF was associated with better functional outcome in SAH patients.

Readmission After Aneurysmal Subarachnoid Hemorrhage: A Nationwide Readmission Database Analysis.

The goal of this nationwide study is to evaluate the suitability of readmission as a quality indicator in the aneurysmal subarachnoid hemorrhage (SAH) population. Patients with aneurysmal SAH were extracted from the Nationwide Readmission Database (2013). Multivariable Cox proportional hazard regression was used to evaluate predictors of a 30-day readmission, and multivariable linear regression was used to analyze the association of hospital readmission rates with hospital mortality rates. Predictors screened included patient demographics, comorbidities, severity of SAH, complications from the SAH hospitalization, and hospital characteristics. The 30-day readmission rate was 10.2% (n=346) among the 3387 patients evaluated, and the most common reasons for readmission were neurological, hydrocephalus, infectious, and venous thromboembolic complications. Greater number of comorbidities, increased severity of SAH, and discharge disposition other than to home were independent predictors of readmission (P≤0.03). Although hydrocephalus during the SAH hospitalization was associated with readmission for the same diagnosis, other readmissions were not associated with having sustained the same complication during the SAH hospitalization. Hospital mortality rate was inversely associated with hospital SAH volume (P=0.03) but not significantly associated with hospital readmission rate; hospital SAH volume was also not associated with SAH readmissions. In this national analysis, readmission was primarily attributable to new medical complications in patients with greater comorbidities and severity of SAH rather than exacerbation of complications from the SAH hospitalization. Additionally, hospital readmission rates did not correlate with other established quality metrics. Therefore, readmission may be a suboptimal quality indicator in the SAH population.

Aneurysm of the levels of Fisher in patients with subarachnoid hematocele and the influence degree of cerebral vasospasm

Objective To investigate closure of different Fisher grade patients with subarachnoid product volume and the degree of cerebral vasospasm aneurysm clipping. Methods Patients with subarachnoid hemorrhage(SAH) were selected from January 2014 to January 2015, including 20 patients with grade Ⅰ, 25 patients with grade Ⅱ, and 15 patients with grade Ⅲ.They were divided into 20 patients with aneurysmal SAH(A group), 18 patients without aneurysmal SAH(B group) and C group(22 cases). The operation effect was compared. Results C group as the standard, CT preoperative diagnosis had no statistically significant difference among A, B, C group (χ2=0.12, P>0.05). After treatment, the cerebral spasticity scores of A, B group were significantly decreased, and the level-Ⅰ and Ⅱ patients decreased more significantly compared with stage Ⅲ patients, the difference between the two groups was statistically significant(χ2=7.05, P<0.05). In group C, the blood flow velocity at the 7th and 13rd day significantly increased(χ2=7.05, P<0.05), and velocity of blood flow in group A and B Ⅰ and Ⅱ patients was significantly higher than that of grade Ⅲ patients (t=8.75, P<0.05). Conclusion For the patients with Fisher grade Ⅰ and Ⅱ, the increase in the volume of subarachnoid hemorrhage, cerebral vasospasm, and the effect of the patients with Ⅲ were more obvious. Key words: Aneurysm clipping; Subarachnoid hemorrhage; Fisher classification; Cerebral vasospasm

Aneurysm location and clipping versus coiling for development of secondary normal-pressure hydrocephalus after aneurysmal subarachnoid hemorrhage: Japanese Stroke DataBank.

The present study aimed to investigate aneurysm locations and treatments for ruptured cerebral aneurysms associated with secondary normal-pressure hydrocephalus (sNPH) after subarachnoid hemorrhage (SAH) by using comprehensive data from the Japanese Stroke DataBank. Among 101,165 patients with acute stroke registered between 2000 and 2013, 4693 patients (1482 men, 3211 women) were registered as having had an SAH caused by a ruptured saccular aneurysm. Of them, 1448 patients (438 men and 1010 women; mean age 61.9 ± 13.4 years) who were confirmed to have or not have coexisting acute hydrocephalus and sNPH were included for statistical analyses. Locations of the ruptured aneurysms were subcategorized into 1 of the following 4 groups: middle cerebral artery (MCA; n = 354), anterior communicating artery and anterior cerebral artery (ACA; n = 496), internal carotid artery (ICA; n = 402), and posterior circulation (n = 130). Locations of 66 of the ruptured aneurysms were unknown/unrecorded. Treatments included craniotomy and clipping alone in 1073 patients, endovascular coil embolization alone in 285 patients, and a combination of coiling and clipping in 17 patients. The age-adjusted and multivariate odds ratios from logistic regression analyses were calculated after stratification using the Fisher CT scale to investigate the effects of the hematoma volume of SAH. Acute hydrocephalus was confirmed in 593 patients, and 521 patients developed sNPH. Patients with a ruptured ACA aneurysm had twice the risk for sNPH over those with a ruptured MCA aneurysm. Those with an ACA aneurysm with Fisher Grade 3 SAH had a 9-fold-higher risk for sNPH than those with an MCA aneurysm with Fisher Grade 1 or 2 SAH. Patients with a ruptured posterior circulation aneurysm did not have any significant risk for sNPH. Clipping of the ruptured aneurysm resulted in twice the risk for sNPH over coil embolization alone. Patients with low-grade SAH caused by a ruptured MCA aneurysm had a low risk for the development of sNPH. In contrast, patients with high-grade SAH caused by a ruptured ACA aneurysm had a higher risk for sNPH. Endovascular coiling might confer a lower risk of developing sNPH than microsurgical clipping.

High Subarachnoid Hemorrhage Patient Volume Associated With Lower Mortality and Better Outcomes

High-volume centers have better outcomes than low-volume centers when managing complex conditions including subarachnoid hemorrhage (SAH). To quantify SAH volume-outcome association and determine the extent to which this association is influenced by aggressiveness of care. A serial cross-sectional retrospective study using the Nationwide Inpatient Sample for 2002 to 2010 was performed. Included were all adult (older than 18 years of age) discharged patients with a primary diagnosis of SAH admitted from the emergency department or transferred to a discharging hospital; cases of trauma or arteriovenous malformation were excluded. Survey-weighted descriptive statistics estimated temporal trends. Multilevel logistic regression estimated volume-outcome associations for inpatient mortality and discharge home. Models were adjusted for demographic characteristics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and all patient-refined, diagnosis-related group mortality. Analyses were repeated, excluding cases in which aggressive care was not pursued. A total of 32,336 discharges were included; 13,398 patients underwent clipping (59.1%) or coiling (40.9%). The inpatient mortality rate decreased from 32.2% in 2002 to 22.2% in 2010; discharge home increased from 28.5% to 40.8% during the same period. As SAH volume decreased from 100/year, the mortality rate increased from 18.7% to 19.8% at 80/year, 21.7% at 60/year, 24.5% at 40/year, and 28.4% at 20/year. As SAH patient volume decreased, the probability of discharge home decreased from 40.3% at 100/year to 38.7% at 60/year, and 35.3% at 20/year. Better outcomes persisted in patients receiving aggressive care and in those not receiving aggressive care. Short-term SAH outcomes have improved. High-volume hospitals have more favorable outcomes than low-volume hospitals. This effect is substantial, even for hospitals conventionally classified as high volume.

Hospital case volume is associated with mortality in patients hospitalized with subarachnoid hemorrhage.

Prior studies have suggested that hospital case volume may be associated with improved outcomes after subarachnoid hemorrhage (SAH), but contemporary national data are limited. To assess the association between hospital case volume for SAH and in-hospital mortality. Using the Get With The Guidelines-Stroke registry, we analyzed patients with a discharge diagnosis of SAH between April 2003 and March 2012. We assessed the association of annual SAH case volume with in-hospital mortality by using multivariable logistic regression adjusting for relevant patient, hospital, and geographic characteristics. Among 31,973 patients with SAH from 685 hospitals, the median annual case volume per hospital was 8.5 (25th-75th percentile, 6.7-12.9) patients. Mean in-hospital mortality was 25.7%, but was lower with increasing annual SAH volume: 29.5% in quartile 1 (range, 4-6.6), 27.0% in quartile 2 (range, 6.7-8.5), 24.1% in quartile 3 (range, 8.5-12.7), and 22.1% in quartile 4 (range, 12.9-94.5). Adjusting for patient and hospital characteristics, hospital SAH volume was independently associated with in-hospital mortality (adjusted odds ratio 0.79 for quartile 4 vs 1, 95% confidence interval, 0.67-0.92). The quartile of SAH volume also was associated with length of stay but not with discharge home or independent ambulatory status. In a large nationwide registry, we observed that patients treated at hospitals with higher volumes of SAH patients have lower in-hospital mortality, independent of patient and hospital characteristics. Our data suggest that experienced centers may provide more optimized care for SAH patients.

Relationship between intracranial pressure and aneurysmal subarachnoid hemorrhage grades

ObjectiveIntracranial pressure (ICP) is frequently elevated following aneurysmal subarachnoid hemorrhage (aSAH). In this prospective study, the factors associated with increased ICP and the relationship between ICP and the aSAH grade were evaluated. MethodsConsecutive patients with prospective aSAH were enrolled within 24h after disease onset. Clinical scoring, including the Hunt and Hess scale, the WFNS scale and the Fisher scale, was performed upon admission. Consciousness was evaluated based on the Glasgow Coma Scale, and the subarachnoid hemorrhage volume was determined according to a CT scan. Then, an ICP monitor was placed, and ICP was recorded. The relationship between ICP and the aSAH grade was examined using Spearman correlation coefficients. Additionally, some clinical characteristics of the patients, including age, sex, location and size of the aneurysm, hydrocephalus and rebleeding, were recorded and analyzed. ResultsA total of 165 patients were enrolled in this study. Of these patients, 111 (67.2%) displayed elevated ICP (≥20mm Hg). The patients who underwent intubation or who experienced rebleeding or hydrocephalus displayed an elevated ICP compared with those who did not (P=0.002, P=0.001 and P=0.008, respectively). There was a positive linear correlation between ICP and both the Hunt and Hess grade and the WFNS grade (correlation coefficients of 0.731 and 0.761, respectively). The correlation between ICP and the Fisher grade was weak according to the correlation coefficient of only 0.093. ConclusionICP following aSAH positively correlates with the patient's consciousness, but no relationship was detected between ICP and the subarachnoid hemorrhage volume.

Abstract W MP100: Hospital SAH Volume Associated With Better Outcomes

Objective: The net impact of hospital care on outcomes in subarachnoid hemorrhage (SAH) has not been well established. We hypothesized that increased experience and technical expertise at high volume hospitals would lead to better outcomes. Methods: We performed a serial cross-sectional retrospective study using the Nationwide Inpatient Sample from 2002-2010. All adult (&gt;18 years) discharges with a primary diagnosis of SAH (ICD-9-CM 435) from 2002-2010 were included and records with trauma or AVM were excluded. Survey-weighted descriptive statistics were used to estimate temporal trends. Multi-level logistic regression was used to estimate volume-outcome associations for two outcomes: inpatient mortality and discharge home. Models were adjusted for demographics, year, transfer status, insurance status, all individual Charlson comorbidities, intubation, and APR-DRG mortality. Analyses were repeated by excluding records where aggressive care was not pursued _ no intubation, no procedures and in-hospital death within 48 hours. Results: A total of 66,818 discharges were included in the weighted sample, including 19, 356 who received clipping or coiling. Inpatient mortality declined from 32.2% (30.1%- 33.9%) to 22.2% (20.8%-23.6%) from 2002 to 2010 while discharges to home increased from 28.5% (27.0-30.03%) to 40.8% (39.1%-42.4%). Hospitals in the highest volume quintile (greater than 63 discharges per year) had an unadjusted inpatient mortality of 22.7% (95% CI 22.0%-23.2%) compared to 41.5% (39.0%-43.7%) in quintile 3 (11-21 discharges per year) compared to 51.9% (47.0 -55.7%) in quintile 1 (less than 6 discharges per year). Similar trends were observed when excluding cases where aggressive care was not pursued. The proportion of patients discharged home also increased with hospital volume: 39.3 %( 38.0-39.9%) in quintile 5 vs. 23.2% (21.0%-25.1%) in quintile 3 vs. 16.7% (13.0%-19.7%) in quintile 1. Conclusion: Inpatient SAH mortality has decreased over time while the likelihood of discharge home has increased. High volume hospitals have more favorable outcomes than low volume hospitals and the magnitude of this effect is substantial. SAH volume should be accounted for in developing SAH systems of care.

Predictors of hemorrhage volume and disability after perimesencephalic subarachnoid hemorrhage

The determinants of subarachnoid hemorrhage (SAH) volume and an atypical pattern of blood are not clear. Our objective was to determine if reduced platelet activity on admission and abnormal venous drainage are associated with greater SAH volume. We prospectively identified noncomatose patients with SAH without an identifiable aneurysm. We routinely measured platelet activity on admission and recorded aspirin use. SAH volumes were calculated with a validated technique. CT angiograms were reviewed by a certified neuroradiologist for venous drainage. Patients were followed for clinical outcomes through 3 months with the modified Rankin Scale (mRS). Data are Q1-Q3. There were 31 patients in the cohort. Thirty (97%) underwent an angiogram on admission, and 25 (81%) an additional delayed angiogram. SAH volume was lowest with normal venous drainage bilaterally (4.4 [3.7-16.4] mL) and higher with 1 (12.9 [3.7-20.4]) or 2 (20.9 [12.5-34.6] mL, p = 0.03) discontinuous venous drainages. Patients with reduced platelet activity had more SAH on the diagnostic CT (17.5 [10.6-20.9] vs 6.1 [2.3-15.3] mL) (p = 0.046). SAH volume was greater for patients requiring drainage for hydrocephalus (16.4 [11.5-20.5] vs 5.4 [2.7-16.4] mL) (p = 0.009). Outcomes at 3 months were generally excellent (median mRS = 0, no symptoms). Discontinuous venous drainage and reduced platelet activity were associated with increased SAH volume and hydrocephalus. These factors may explain thick SAH and reduce the need for repeated invasive imaging in such patients.

The Relationship Between Subarachnoid Hemorrhage Volume and Development of Cerebral Vasospasm

ObjectiveThe objective of this study is to verify the relationship between subarachnoid hemorrhage (SAH) volume (not Fisher grade) and development of cerebral vasospasm prospectively.MethodsPatients who visited our hospital with a diffuse or localized thick subarachnoid blood clot seen on computed tomography (CT), taken within 48 hours after SAH and the aneurysm was confirmed by CT Angiogram (CTA) from March 2010 to July 2011 were enrolled in this study. CTA was checked at least twice after admission. Angiographic vasospasm (AVS) on CTA was defined as irregularity or narrowing of intracranial vessels on follow up CTA compared with initial CTA. Total intracranial hemorrhage (ICH) volume (subdural, SAH, intracerebral and intraventricular) was calculated and SAH volume (all supratentorial and infratentorial cisterns) was also calculated using the MIPAV software package.ResultsA total of 55 patients were included in our study. Thirty six patients did not show AVS on CTA or clinical deterioration (non vasospasm group: NVS). AVS without ischemic neurologic symptoms was observed in four patients and development of symptomatic vasospasm (SVS), defined as AVS with ischemic symptoms, was observed in 15 patients. SAH volume in SVS patients was statistically larger than that in NVS patients (p < 0.05). Total ICH volume in SVS patients was larger than that in NVS patients. However, the difference was not statistically significant.ConclusionResults of this study indicate an association of development of vasospasm with the SAH volume, not intracranial hemorrhage.

The Clinical Implications of Subarachnoid Hemorrhage Volume

The Clinical Implications of Subarachnoid Hemorrhage Volume

Quantification of Subarachnoid Hemorrhage by Three-Dimensional Computed Tomography: Correlation Between Hematoma Volume and Symptomatic Vasospasm

Subarachnoid hemorrhage (SAH) volume was measured by three-dimensional computed tomography (3D-CT) and the correlation examined between the SAH volume and the occurrence of symptomatic vasospasm (SVS). Experimental (in vitro) hematomas were made with blood obtained from 10 volunteers. The hematoma volume was determined by actual measurements and by 3D-CT using a CT number in the range of 40-80 Hounsfield units (HU) on days 1, 4, 7, 11, and 14. The coefficients on days 1 and 4 were relatively high and the correlation between measured and estimated volumes was significant on days 7, 11, and 14. 3D-CT was also performed in 50 patients with SAH at onset (day 0) and on days 1, 4, 7, and 14. The hematoma volume including the volume of normal structures was automatically calculated (V1). The volume of normal structures (V2) with CT numbers of 40-80 HU was calculated in another 50 patients without intracranial lesions as 12 ml. The total hematoma volume was defined as V1 minus mean V2. The mean SAH volume was 44, 36, 21, 11, and 8 ml on days 0, 1, 4, 7, and 14, respectively. The hematoma volumes were significantly larger in patients with SVS than in patients without SVS at all time points. The minimum hematoma volume in patients with SVS was 92, 76, 42, 24, and 12 ml on days 0, 1, 4, 7, and 14, respectively. This method allows the quantitative determination of SAH volume based on 3D-CT, and may be useful in clinical studies of cerebral vasospasm.