Diffusion-Perfusion Mismatch in Symptomatic Vasospasm After Subarachnoid Hemorrhage

Ohtonari, Tatsuya; Kakinuma, Kenichi; Kito, Tomohiro; Ezuka, Isamu; Kanazawa, Tsutomu

doi:10.2176/nmc.48.331

Cited by 14 publications

(4 citation statements)

References 26 publications

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“…However, the numbers of patients looked at with such techniques are small and much larger studies are required. Diffusion-perfusion mismatch may be seen ( 105 , 106 ). However, it may be technically difficult in the presence of large amounts of blood products and it has not been compared to other methods including transcranial Doppler (TCD) ultrasonography or Perfusion CT.…”

Section: Biomarkers Of Brain Structural Imagingmentioning

confidence: 99%

Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

et al. 2015

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Much progress has been made over the past two decades in the treatment of severe acute brain injury, including traumatic brain injury and subarachnoid hemorrhage, resulting in a higher proportion of patients surviving with better outcomes. This has arisen from a combination of factors. These include improvements in procedures at the scene (pre-hospital) and in the hospital emergency department, advances in neuromonitoring in the intensive care unit, both continuously at the bedside and intermittently in scans, evolution and refinement of protocol-driven therapy for better management of patients, and advances in surgical procedures and rehabilitation. Nevertheless, many patients still experience varying degrees of long-term disabilities post-injury with consequent demands on carers and resources, and there is room for improvement. Biomarkers are a key aspect of neuromonitoring. A broad definition of a biomarker is any observable feature that can be used to inform on the state of the patient, e.g., a molecular species, a feature on a scan, or a monitoring characteristic, e.g., cerebrovascular pressure reactivity index. Biomarkers are usually quantitative measures, which can be utilized in diagnosis and monitoring of response to treatment. They are thus crucial to the development of therapies and may be utilized as surrogate endpoints in Phase II clinical trials. To date, there is no specific drug treatment for acute brain injury, and many seemingly promising agents emerging from pre-clinical animal models have failed in clinical trials. Large Phase III studies of clinical outcomes are costly, consuming time and resources. It is therefore important that adequate Phase II clinical studies with informative surrogate endpoints are performed employing appropriate biomarkers. In this article, we review some of the available systemic, local, and imaging biomarkers and technologies relevant in acute brain injury patients, and highlight gaps in the current state of knowledge.

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Section: Biomarkers Of Brain Structural Imagingmentioning

confidence: 99%

Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

et al. 2015

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“…So far, cerebral angiography remains the gold standard for the diagnosis of vasospasm and can be both diagnostic and therapeutic. The use of modalities like DWI/PWI mismatch, perfusion MRI or CT to detect and quantify vasospasm is currently evaluated (120, 121).…”

Section: Specific Treatmentmentioning

confidence: 99%

Intensive Care Management of Acute Stroke: General Management

Diedler

Sýkora

Jüttler

et al. 2009

International Journal of Stroke

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For a long time, patients with severe stroke were facing therapeutic nihilism of the attending physicians. Implementation of do-not-resuscitate-orders may have lead to self-fulfilling prophecies and to a pessimistic overestimation of prognosis of severe stroke syndromes. However, there have been great advances in intensive care management of acute stroke patients and it has been shown that treatment on a specialised neurological intensive care unit improves outcome. In this review, we will present a summary of the current state-of-the-art intensive care management of acute stroke patients. After presenting an overview on general management of stroke intensive care patients, special aspects of neurological intensive care of acute large middle cerebral artery stroke, intracerebral haemorrhage and subarachnoid haemorrhage will be discussed. In part II of the review, surgical management options for acute stroke will be discussed in detail.

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“…perfusion-weighted imaging (PWI) or magnetic resonance (MR) imaging [3,4], single photon emission computed tomography [5], positron emission tomography (PET) [6], and computed tomography (CT) have been reported to be advantageous in guiding management of the vasospasm [1]. However, diagnostic accuracy varies with time, and serial measurements are necessary.…”

Section: Introductionmentioning

confidence: 99%

Detection of symptomatic vasospasm after subarachnoid haemorrhage: initial findings from single time-point and serial measurements with arterial spin labelling

et al. 2012

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• MR arterial spin labelling (ASL) can non-invasively assess cerebral blood flow (CBF) • ASL revealed significant CBF reduction in symptomatic hemispheres compared with asymptomatic hemispheres • Serial ASL measurements enable observation of time-dependent CBF changes after SAH • ASL is non- invasive and suitable for serial repeated examinations.

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Diffusion-Perfusion Mismatch in Symptomatic Vasospasm After Subarachnoid Hemorrhage

Cited by 14 publications

References 26 publications

Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

Systemic, Local, and Imaging Biomarkers of Brain Injury: More Needed, and Better Use of Those Already Established?

Intensive Care Management of Acute Stroke: General Management

Detection of symptomatic vasospasm after subarachnoid haemorrhage: initial findings from single time-point and serial measurements with arterial spin labelling

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