Early cerebral infarction after aneurysmal subarachnoid hemorrhage is associated with prior global cerebral hypoperfusion.
Simonato D., Gaugain S., Le Dorze M., Prisco L., Borchert RJ., Fuschi M., Patel J., Mebazaa A., Froelich S., Houdart E., Chousterman B., Labeyrie M-A.
BACKGROUND AND PURPOSE: 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. METHODS: We performed a retrospective cohort study of consecutive patients admitted for aSAH in two centers. ECI was defined as any radiological cerebral infarction identified within 3 days 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. RESULTS: Seven-hundred-and-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) vs. in 11% of patients without ECI (P