Meza-Cano ME, Treviño-Frutos R, Ramírez-Rosales A, Cobos-Aguilar H

Language: Spanish
References: 15
Page: 15-21
PDF size: 532.37 Kb.

ABSTRACT

Objective: To determine if risk factors such as advanced age, history of hypertension or diabetes, initial neurologic status, radiological grade of the subarachnoid hemorrhage, therapeutic hypertension, presence of fever, vasospasm and symptomatic vasospasm are associated with the presence of cerebral infarction in aneurismatic subarachnoid hemorrhage (ASAH) treated with endovascular therapy. Material and methods: we conduct a case-control study in the Christus Muguerza Alta Especialidad Hospital in Monterrey, Nuevo Leon, from medical records of the patients, in a period from January 2007 to May 2012. Results: during the period from January 2007 to May 2012 were reviewed 200 cases, and were identified 12 cases with infarction and 22 controls without infarction, both with ASAH and treated with endovascular therapy (relationship cases - controls 1: 1.8), in the population of Christus Muguerza Alta Especialidad Hospital in Monterrey, Nuevo Leon. We found that for the cases 66.6% were male and 33.3% were female, for the controls 77.2% female and 22.7% were male. With an average age of 54 years for cases and 50 years for controls. Risk factors associated with cerebral infarction in ASAH are the presence of hypertension (OR: 6.3 1.035-43.02 95% p=0.016), male sex (OR: 6.8 95% CI 1.14-45.52 p=0.02), presence of intraventricular hemorrhage (OR: 8.7 95% CI 1.25-77.1 p=0.011). The most important risk factor was the presence of vasospasm, which increases 17 times the probability of infarction (OR: 17, 95% CI: 2.23-168.25, P = 0.001), and symptomatic vasospasm increases 29 times the risk of stroke (OR: 29.4, 95% CI 2.45-809.79, p = 0.001). Also, a binary logistic regression analysis for risk factors was conducted, in which only one variable was significant: symptomatic vasospasm (OR: 16.75 95% CI 0.74 - 375.72, p = 0.0001). Conclusion: symptomatic vasospasm is the most important risk factor for the presence of cerebral infarction in ASAH.

REFERENCES

1. Singer R, Olgilvy C, Rodorf G. Etiology, clinical manifestations, and diagnosis of aneurysmal subarachnoid hemorrhage. 2011 Uptodate.com.

2. Becske T, Jallo G, Lutsep H. Subarachnoid hemorrhage. 2011. Medscape.com.

3. Rabinstein AA, Friedman JA, Weigand SD, McClelland RL, Fulgham JR, Manno EM, Atkinson JL, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke 2004;35(8):1862-6.

4. Adams HP Jr, Kassell NF, Torner JC, Haley EC. Predicting cerebral ischemia after aneurysmal subarachnoid hemorrhage: influences of clinical condition, CT results, and antifibrinolytic therapy. A report of the cooperative aneurysm study. Neurol 1987;37(10):1586-91.

5. Ohman J, Servo A, Heiskanen O. Risks factors for cerebral infarction in good-grade patients after aneurysmal subarachnoid hemorrhage and surgery: a prospective study. J Neurosurg 1991;74(1):14-20.

6. Fergusen S, Macdonald RL. Predictors of cerebral infarction in patients with aneurysmal subarachnoid hemorrhage. Neurosurgery 2007;60(4):658-67.

7. Sehba FA, Pluta RM, Zhang JH. Metamorphosis of subarachnoid hemorrhage research: from delayed vasospasm to early brain injury. Mol Neurobiol 2011;43(1):27-40.

8. Velasco V, Roiz J, Huazano F, Nieves A, Martínez V. Muestreo y tamaño de muestra: una guía práctica para personal de la salud que realiza investigación. Editores independientes. 2003.

9. Suarez J, Tarr R, Selman W. Aneurysmal subarachnoid hemorrhage. N Engl J Med 2006;354:387-96.

10. Vergouwen MD, Vermeulen M, van Gijn J. 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.

11. Juvela S, Siironen J. Early cerebral infarction as a risk factor for poor outcome after aneurysmal subarachnoid haemorrhage. Eur J Neurol 2012;19(2):332-9.

12. Teasdale GM, GC Drake, W Hunt, Kassell N, K Sano, B Pertuiset, et al. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies. Hemorragia subaracnoidea una escala universal. J Neurol Neurosurg Psiquiatría 1988;51(11):1457.

13. Rabinstein AA, Weigand S, Atkinson JL, Wijdicks EF. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke 2005; 36:992.

14. Juvela S, Siironen J, Varis J, Poussa K, Porras M. Risk factors for ischemic lesions following aneurysmal subarachnoid hemorrhage. J Neurosurg 2005;102(2):194.

15. Rabinstein A, Lanzino G, Wijdicks F. Multidisciplinary management and emerging therapeutic strategies in aneurysmal subarachnoid haemorrhage. Lancet Neurol 2010;(9)504- 19.