Clinical Implications of Subarachnoid Clots Detected by Diffusion-Weighted Imaging in the Acute Stage of Aneurysm Rupture

In this report, the authors sought to summarize existing literature to provide an overview of the currently available techniques and to critically assess the evidence for or against their application in intracerebral hemorrhage (ICH) for management, prognostication, and research. Functional imaging in ICH represents a potential major step forward in the ability of physicians to assess patients suffering from this devastating illness due to the advantages over standing imaging modalities focused on general tissue structure alone, but its use is highly controversial due to the relative paucity of literature and the lack of consolidation of the predominantly small data sets that are currently in existence. Current data support that diffusion tensor imaging and tractography, diffusion-perfusion weighted MRI techniques, and functional MRI all possess major potential in the areas of highlighting motor deficits, motor recovery, and network reorganization. Novel clinical studies designed to objectively assess the value of each of these modalities on a wider scale in conjunction with other methods of investigation and management will allow for their rapid incorporation into standard practice.

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“…37,39,41 Of particular promise is the use of DTI in the assessment of corticospinal tract injury after ICH (Fig. 1).…”

Section: Prognostication After Ichmentioning

confidence: 99%

The role of advanced neuroimaging in intracerebral hemorrhage

McDowell

Kellner²,

Barton³

et al. 2013

FOC

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“…Future studies will likely extend the use of GRE and SWI for other features of SAH 29. DWI findings of subarachnoid clots and parenchymal DWI abnormalities at baseline have been used to determine likely prognosis 30, 31. More extensive DWI changes in parenchyma have been implicated in subsequent vasospasm 32.…”

Section: Hemorrhage Patternsmentioning

confidence: 99%

Imaging the future of stroke: II. Hemorrhage

Liebeskind

2010

Annals of Neurology

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Bleeding into the brain or adjacent structures is one of the most devastating neurological conditions, incurring tremendous emotional, financial, and societal costs. Imaging is essential to differentiate variants of hemorrhage, as the clinical features may be insufficient. A comprehensive approach to hemorrhage therefore relies on imaging to disclose pathophysiology, elucidate mechanisms, and thereby open further avenues to effective treatment. Hemorrhage patterns from superficial to deep locations in the brain are surveyed in this work, noting myriad potential causes and the influential pathophysiology of arterial ischemia, venous hypertension, and microvascular dysfunction. Recent progress of imaging studies and novel techniques to evaluate hemorrhage are explored. For decades, only computed tomography was available to define a hematoma without corroborating evidence of other pathology whereas multimodal computed tomography and magnetic resonance imaging, including noninvasive imaging of brain tissue, vessels, and perfusion, have now radically altered clinical practice. Imaging of the blood-brain barrier, cerebral microbleeds, coexistent ischemia, associated vascular lesions, and markers of hemorrhage expansion is possible with routine protocols akin to diagnostic strategies for ischemic stroke. Imaging applications for hemorrhagic transformation, venous thrombosis, and microvascular disorders are considered with a perspective that balances concern for hemorrhage with prevention of ischemia as these processes are often intertwined and clinical conundrums arise. Imminent imaging advances are anticipated with increased use of detailed imaging for hemorrhage and overlap with cerebral ischemia. Numerous questions abound regarding optimal management of hemorrhage and definitive treatments are lacking, yet imaging of pivotal pathophysiology offers tremendous opportunity for future progress in combating this debilitating condition.

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Redefining Secondary Injury After Subarachnoid Hemorrhage in Light of Multimodal Advanced Neuroimaging, Intracranial and Transcranial Neuromonitoring: Beyond Vasospasm

Kapinos

2014

Acta Neurochirurgica Supplement

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The classic idea that arterial narrowing, called vasospasm (VSP), represents the hallmark of secondary injury after subarachnoid hemorrhage, has been challenged. The more complex and pleiotropic pathophysiological repercussions from the irruption of arterial blood into the subarachnoid layers go beyond the ascribed VSP. Putting adjectives in front of this term, such as "symptomatic," "microdialytic," or "angiographic" VSP, is misleading. Delayed cerebral ischemia (DCI) is a better term but remains restrictive to severe hypoperfusive injury and neglects oligemia, edema, and metabolic nonischemic injuries. In recognition of these issues, the international conference on VSP integrated "neurovascular events" into its name ( www.vasospasm2013.com ) and a multidisciplinary research group was formed in 2010 to study subgroups of DCI/VSP and their respective significance.In three parts, this tiered article provides a broader definitional envelope for DCI and secondary neurovascular insults after SAH, with a rubric for each subtype of delayed neuronal dysfunction. First, it pinpoints the need for nosologic precision and covers current terminological inconsistency. Then, it highlights the input of neuroimaging and neuromonitoring in defining secondary injurious processes. Finally, a new categorization of deteriorating patients is proposed, going beyond a hierarchical or dichotomized definition of VSP/DCI, and common data elements are suggested for future trials.

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Clinical Implications of Subarachnoid Clots Detected by Diffusion-Weighted Imaging in the Acute Stage of Aneurysm Rupture

Cited by 4 publications

References 24 publications

The role of advanced neuroimaging in intracerebral hemorrhage

The role of advanced neuroimaging in intracerebral hemorrhage

Imaging the future of stroke: II. Hemorrhage

Redefining Secondary Injury After Subarachnoid Hemorrhage in Light of Multimodal Advanced Neuroimaging, Intracranial and Transcranial Neuromonitoring: Beyond Vasospasm

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