Key result
Among aSAH patients in initially good clinical condition who developed devastating delayed cerebral ischemia, 81% experienced blood pressure instability prior to DCI onset.
Why the study?
The proportion of aneurysmal subarachnoid hemorrhage patients in an initial good clinical condition who develop devastating delayed cerebral ischemia, and their clinical characteristics, remained to be investigated.
Observational (n=16)
No
Devastating delayed cerebral ischemia is rare (3%) among aSAH patients in initially good clinical condition, but is strongly associated with preceding blood pressure instability.
Answers are grounded in this paper and cite their sources.
Devastating DCI remains rare (3%) in good-grade aSAH; leaves open whether blood pressure instability is causal or a modifiable target.
Background: We investigated the proportion of patients in an initial good clinical condition who developed devastating DCI, and aimed to characterize these patients by aneurysm location, blood pressure instability prior to DCI, and the extent of cerebral ischemia. Methods: We included aSAH patients admitted between 2010 and 2021 with a Glasgow Coma Scale of 11 or higher 24 h after aneurysm treatment, who developed devastating DCI, defined as DCI leading to coma for at least 48 h with cerebral infarction on the subsequent scan. Blood pressure instability was defined as nimodipine-induced blood pressure drops, dosage adjustments, or the use of blood pressure drugs before onset of DCI. Descriptive statistics were used to summarize the data. Results: Out of 1,211 consecutive aSAH patients, 617 patients had a good clinical condition after aneurysm treatment of whom 16 (3%) patients [14 (88%) women] were included in this study. Thirteen (81%) patients had an aneurysm in the anterior circulation. Thirteen patients (81%) had blood pressure instability: twelve (75%) had nimodipine-induced blood pressure drops, eleven (69%) received antihypertensive drugs, and 7 (44%) received hypertension induction before onset of DCI. Thirteen (81%) patients had bilateral ischemia, mainly in the anterior circulation (56%). Conclusions: The proportion of aSAH patients with a good clinical condition after aneurysm treatment who develop devastating DCI is small. The vast majority of these patients had blood pressure instability. Future studies are needed to investigate if a reduction in the number and extent of blood pressure fluctuations decreases the incidence of devastating DCI.
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Koopman et al. (2022) conducted an observational in Aneurysmal subarachnoid hemorrhage (aSAH) with devastating delayed cerebral ischemia (DCI) (n=16). Blood pressure instability was evaluated on Proportion of patients with blood pressure instability prior to devastating DCI. Among aSAH patients in initially good clinical condition who developed devastating delayed cerebral ischemia, 81% experienced blood pressure instability prior to DCI onset.
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