Skip to main content
Erschienen in: Neurocritical Care 3/2016

16.11.2015 | Original Article

MRI Detection of Cerebral Infarction in Subarachnoid Hemorrhage

verfasst von: Georgia Korbakis, Shyam Prabhakaran, Sayona John, Rajeev Garg, James J. Conners, Thomas P. Bleck, Vivien H. Lee

Erschienen in: Neurocritical Care | Ausgabe 3/2016

Einloggen, um Zugang zu erhalten

Abstract

Objective

To investigate magnetic resonance imaging (MRI) detection of cerebral infarction (CI) in patients presenting with subarachnoid hemorrhage (SAH).

Background

CI is a well-known complication of SAH that is typically detected on computed tomography (CT). MRI has improved sensitivity for acute CI over CT, particularly with multiple, small, or asymptomatic lesions.

Methods

With IRB approval, 400 consecutive SAH patients admitted to our institution from August 2006 to March 2011 were retrospectively reviewed. Traumatic SAH and secondary SAH were excluded. Data were collected on demographics, cause of SAH, Hunt Hess and World Federation of Neurosurgical Societies grades, and neuroimaging results. MRIs were categorized by CI pattern as single cortical (SC), single deep (SD), multiple cortical (MC), multiple deep (MD), and multiple cortical and deep (MCD).

Results

Among 123 (30.8 %) SAH patients who underwent MRIs during their hospitalization, 64 (52 %) demonstrated acute CI. The mean time from hospital admission to MRI was 5.7 days (range 0–29 days). Among the 64 patients with MRI infarcts, MRI CI pattern was as follows: MC in 20 (31 %), MCD in 18 (28 %), SC in 16 (25 %), SD in 3 (5 %), MD in 2 (3 %), and 5 (8 %) did not have images available for review. Most infarcts detected on MRI (39/64 or 61 %) were not visible on CT.

Conclusions

The use of MRI increases the detection of CI in SAH. Unlike CT studies, MRI-detected CI in SAH tends to involve multiple vascular territories. Studies that rely on CT may underestimate the burden of CI after SAH.
Literatur
1.
Zurück zum Zitat Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38:2315–21.CrossRefPubMed Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38:2315–21.CrossRefPubMed
2.
Zurück zum Zitat Vergouwen MDI, Ilodigwe D, Macdonald RL. Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke. 2011;42:924–9.CrossRefPubMed Vergouwen MDI, Ilodigwe D, Macdonald RL. Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke. 2011;42:924–9.CrossRefPubMed
3.
Zurück zum Zitat Fergusen S, Macdonald RL. Predictors of cerebral infarction in patients with aneursymal subarachnoid hemorrhage. Neurosurgery. 2007;60:658–67.CrossRefPubMed Fergusen S, Macdonald RL. Predictors of cerebral infarction in patients with aneursymal subarachnoid hemorrhage. Neurosurgery. 2007;60:658–67.CrossRefPubMed
4.
Zurück zum Zitat Rabinstein AA, Weigand S, Atkinson JLD, Wijdicks EF. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2005;36:992–7.CrossRefPubMed Rabinstein AA, Weigand S, Atkinson JLD, Wijdicks EF. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2005;36:992–7.CrossRefPubMed
5.
Zurück zum Zitat Temes RE, Tessitore E, Schmidt JM, et al. Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2010;13:359–65.CrossRefPubMed Temes RE, Tessitore E, Schmidt JM, et al. Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2010;13:359–65.CrossRefPubMed
6.
Zurück zum Zitat Kilbourn KJ, Levy S, Staff I, Kureshi I, McCullough L. Clinical characteristics and outcomes of neurogenic stress cardiomyopathy in aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 2013;115:909–14.CrossRefPubMed Kilbourn KJ, Levy S, Staff I, Kureshi I, McCullough L. Clinical characteristics and outcomes of neurogenic stress cardiomyopathy in aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 2013;115:909–14.CrossRefPubMed
7.
Zurück zum Zitat Vergouwen MD, Vermeulen M, Coert BA, Stroes ES, Roos YB. Microthrombosis after aneurismal subarachnoid hemorrhage: an additional explanation for delayed cerebral ischemia. J Cereb Blood Flow Metab. 2008;28:1761–70.CrossRefPubMed Vergouwen MD, Vermeulen M, Coert BA, Stroes ES, Roos YB. Microthrombosis after aneurismal subarachnoid hemorrhage: an additional explanation for delayed cerebral ischemia. J Cereb Blood Flow Metab. 2008;28:1761–70.CrossRefPubMed
8.
Zurück zum Zitat Stein SC, Browne KD, Chen XH, Smith DH, Graham DI. Thromboembolism and delayed cerebral ischemia after subarachnoid hemorrhage: an autopsy study. Neurosurgery. 2006;59(4):781–7.CrossRefPubMed Stein SC, Browne KD, Chen XH, Smith DH, Graham DI. Thromboembolism and delayed cerebral ischemia after subarachnoid hemorrhage: an autopsy study. Neurosurgery. 2006;59(4):781–7.CrossRefPubMed
9.
Zurück zum Zitat Dreier JP, Woitzik J, Fabricius M, et al. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain. 2006;129:3224–37.CrossRefPubMed Dreier JP, Woitzik J, Fabricius M, et al. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain. 2006;129:3224–37.CrossRefPubMed
10.
Zurück zum Zitat Wagner M, Steinbes P, Güresir E, et al. Beyond delayed cerebral vasospasm: infarct patterns in patients with subarachnoid hemorrhage. Clin Neuroradiol. 2013;23:87–95.CrossRefPubMed Wagner M, Steinbes P, Güresir E, et al. Beyond delayed cerebral vasospasm: infarct patterns in patients with subarachnoid hemorrhage. Clin Neuroradiol. 2013;23:87–95.CrossRefPubMed
11.
Zurück zum Zitat Hijdra A, Van Gijn J, Stefanko S, Van Dongen KJ, Vermeulen M, Van Crevel H. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. Neurology. 1986;36:329–33.CrossRefPubMed Hijdra A, Van Gijn J, Stefanko S, Van Dongen KJ, Vermeulen M, Van Crevel H. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. Neurology. 1986;36:329–33.CrossRefPubMed
12.
Zurück zum Zitat Vergouwen MD, Vermeulen M, van Gijn J, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391–5.CrossRefPubMed Vergouwen MD, Vermeulen M, van Gijn J, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391–5.CrossRefPubMed
13.
Zurück zum Zitat Crowley RW, Medel R, Dumont AS, et al. Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke. 2011;42:919–23.CrossRefPubMed Crowley RW, Medel R, Dumont AS, et al. Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke. 2011;42:919–23.CrossRefPubMed
14.
Zurück zum Zitat Rabinstein AA, Friedman JA, Weigand SD, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004;35(8):1862–6.CrossRefPubMed Rabinstein AA, Friedman JA, Weigand SD, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004;35(8):1862–6.CrossRefPubMed
15.
Zurück zum Zitat Naidech AM, Bendok BR, Bassin SL, Bernstein RA, Batjer HH, Bleck TP. Classification of cerebral infarction after subarachnoid hemorrhage impacts outcome. Neurosurgery. 2009;64(6):1052–7.CrossRefPubMed Naidech AM, Bendok BR, Bassin SL, Bernstein RA, Batjer HH, Bleck TP. Classification of cerebral infarction after subarachnoid hemorrhage impacts outcome. Neurosurgery. 2009;64(6):1052–7.CrossRefPubMed
16.
Zurück zum Zitat Frontera JA, Fernandez A, Schmidt JM, et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke. 2009;40:1963–8.CrossRefPubMed Frontera JA, Fernandez A, Schmidt JM, et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke. 2009;40:1963–8.CrossRefPubMed
17.
Zurück zum Zitat Macdonald RL, Kassell NF, Mayer S, et al. Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke. 2008;39:3015–21.CrossRefPubMed Macdonald RL, Kassell NF, Mayer S, et al. Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke. 2008;39:3015–21.CrossRefPubMed
18.
Zurück zum Zitat Forssell A, Larsson C, Ronnberg J, Fodstad H. CT assessment of subarachnoid haemorrhage: a comparison between different CT methods of grading subarachnoid haemorrhage. Br J Neurosurg. 1995;9:21–7.CrossRefPubMed Forssell A, Larsson C, Ronnberg J, Fodstad H. CT assessment of subarachnoid haemorrhage: a comparison between different CT methods of grading subarachnoid haemorrhage. Br J Neurosurg. 1995;9:21–7.CrossRefPubMed
19.
Zurück zum Zitat De Rooij NK, Frijns CJ, Velthuis BK, Rinkel GJ. Secondary infarction in single or in multiple vascular territories: two different entities following subarachnoid hemorrhage? J Neurol. 2011;258:2133–9.CrossRefPubMedPubMedCentral De Rooij NK, Frijns CJ, Velthuis BK, Rinkel GJ. Secondary infarction in single or in multiple vascular territories: two different entities following subarachnoid hemorrhage? J Neurol. 2011;258:2133–9.CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Hadeishi H, Suzuki A, Yasui N, Hatazawa J, Shimosegawa E. Diffusion-weighted magnetic resonance imaging in patients with subarachnoid hemorrhage. Neurosurgery. 2002;50:741–8.CrossRefPubMed Hadeishi H, Suzuki A, Yasui N, Hatazawa J, Shimosegawa E. Diffusion-weighted magnetic resonance imaging in patients with subarachnoid hemorrhage. Neurosurgery. 2002;50:741–8.CrossRefPubMed
21.
Zurück zum Zitat Wartenberg KE, Sheth SJ, Schmidt MJ, et al. Acute ischemic injury on diffusion-weighted magnetic resonance imaging after poor grade subarachnoid hemorrhage. Neurocrit Care. 2011;14(3):407–15.CrossRefPubMed Wartenberg KE, Sheth SJ, Schmidt MJ, et al. Acute ischemic injury on diffusion-weighted magnetic resonance imaging after poor grade subarachnoid hemorrhage. Neurocrit Care. 2011;14(3):407–15.CrossRefPubMed
22.
Zurück zum Zitat Shimoda M, Takeuchi M, Tominaga J, Oda S, Kumasaka A, Tsugane R. Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic resonance imaging. Neurosurgery. 2001;49:1341–50.CrossRefPubMed Shimoda M, Takeuchi M, Tominaga J, Oda S, Kumasaka A, Tsugane R. Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic resonance imaging. Neurosurgery. 2001;49:1341–50.CrossRefPubMed
23.
Zurück zum Zitat Kramer AH, Mikolaenko I, Deis N, et al. Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. Neurosurgery. 2010;67(4):1044–53.CrossRefPubMed Kramer AH, Mikolaenko I, Deis N, et al. Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. Neurosurgery. 2010;67(4):1044–53.CrossRefPubMed
24.
Zurück zum Zitat Gross BA, Lin N, Rerichs KU, Du R. Vasospasm after spontaneous angiographically negative subarachnoid hemorrhage. Acta Neurochir. 2012;154:1127–33.CrossRefPubMed Gross BA, Lin N, Rerichs KU, Du R. Vasospasm after spontaneous angiographically negative subarachnoid hemorrhage. Acta Neurochir. 2012;154:1127–33.CrossRefPubMed
25.
Zurück zum Zitat Kumar A, Brown R, Dhar R, et al. Early vs. delayed cerebral infarction after aneurysm repair after subarachnoid hemorrhage. Neurosurgery. 2013;74:617–23.CrossRef Kumar A, Brown R, Dhar R, et al. Early vs. delayed cerebral infarction after aneurysm repair after subarachnoid hemorrhage. Neurosurgery. 2013;74:617–23.CrossRef
26.
Zurück zum Zitat Hoh BL, Topcuoglu MA, Singhal AB, et al. Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2004;55:779–89.CrossRefPubMed Hoh BL, Topcuoglu MA, Singhal AB, et al. Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2004;55:779–89.CrossRefPubMed
27.
Zurück zum Zitat Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms: a prospective randomized study. Stroke. 2000;31:2369–77.CrossRefPubMed Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms: a prospective randomized study. Stroke. 2000;31:2369–77.CrossRefPubMed
28.
Zurück zum Zitat Rabinstein AA, Pichelmann MA, Friedman JA, et al. Symptomatic vasospasm and outcomes following aneurysmal subarachnoid hemorrhage: a comparison between surgical repair and endovascular coil occlusion. J Neurosurg. 2003;98:319–25.CrossRefPubMed Rabinstein AA, Pichelmann MA, Friedman JA, et al. Symptomatic vasospasm and outcomes following aneurysmal subarachnoid hemorrhage: a comparison between surgical repair and endovascular coil occlusion. J Neurosurg. 2003;98:319–25.CrossRefPubMed
29.
Zurück zum Zitat Cronqvist M, Wirestam R, Ramgren B, et al. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results MR findings and clinical outcome. Neuroradiology. 2005;47:855–73.CrossRefPubMed Cronqvist M, Wirestam R, Ramgren B, et al. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results MR findings and clinical outcome. Neuroradiology. 2005;47:855–73.CrossRefPubMed
30.
Zurück zum Zitat Soeda A, Sakai N, Sakai H, et al. Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2003;24:127–32.PubMed Soeda A, Sakai N, Sakai H, et al. Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2003;24:127–32.PubMed
31.
Zurück zum Zitat Rordorf G, Bellon RJ, Budzik RE, et al. Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. AJNR Am J Neuroradiol. 2001;22:5–10.PubMed Rordorf G, Bellon RJ, Budzik RE, et al. Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. AJNR Am J Neuroradiol. 2001;22:5–10.PubMed
32.
Zurück zum Zitat Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6:611–9.CrossRefPubMed Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6:611–9.CrossRefPubMed
33.
Zurück zum Zitat Vergouwen MD, Etminan N, Ilodigwe D, Macdonald RL. Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2011;31:1545–53.CrossRefPubMedPubMedCentral Vergouwen MD, Etminan N, Ilodigwe D, Macdonald RL. Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2011;31:1545–53.CrossRefPubMedPubMedCentral
34.
Zurück zum Zitat Schmidt JM, Rincon F, Fernandez A, et al. Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care. 2004;7:10–7.CrossRef Schmidt JM, Rincon F, Fernandez A, et al. Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care. 2004;7:10–7.CrossRef
35.
Zurück zum Zitat Shimoda M, Hoshikawa K, Shiramizu H, et al. Early infarction detection by diffusion-weighted imaging in patients with subarachnoid hemorrhage. Acta Neurochir. 2010;52:1197–205.CrossRef Shimoda M, Hoshikawa K, Shiramizu H, et al. Early infarction detection by diffusion-weighted imaging in patients with subarachnoid hemorrhage. Acta Neurochir. 2010;52:1197–205.CrossRef
36.
Zurück zum Zitat Sato K, Shimizu H, Fujimura M, Inoue T, Matsumoto Y, Tominaga T. Acute-stage diffusion-weighted magnetic resonance imaging for predicting outcome of poor-grade aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2010;30:1110–20.CrossRefPubMedPubMedCentral Sato K, Shimizu H, Fujimura M, Inoue T, Matsumoto Y, Tominaga T. Acute-stage diffusion-weighted magnetic resonance imaging for predicting outcome of poor-grade aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2010;30:1110–20.CrossRefPubMedPubMedCentral
37.
Zurück zum Zitat Frontera JA, Ahmed W, Zach V, et al. Acute ischaemia after subarachnoid hemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study. J Neurol Neurosurg Psychiatry. 2015;86(1):71–8.CrossRefPubMed Frontera JA, Ahmed W, Zach V, et al. Acute ischaemia after subarachnoid hemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study. J Neurol Neurosurg Psychiatry. 2015;86(1):71–8.CrossRefPubMed
Metadaten
Titel
MRI Detection of Cerebral Infarction in Subarachnoid Hemorrhage
verfasst von
Georgia Korbakis
Shyam Prabhakaran
Sayona John
Rajeev Garg
James J. Conners
Thomas P. Bleck
Vivien H. Lee
Publikationsdatum
16.11.2015
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 3/2016
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-015-0212-z

Weitere Artikel der Ausgabe 3/2016

Neurocritical Care 3/2016 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Neu im Fachgebiet Neurologie

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.