Significance of Pupillary Findings in Decision Making and Outcomes of World Federation of Neurological Societies Grade V Subarachnoid Hemorrhage

Kobata, Hitoshi; Ikawa, Fusao; Sato, Akira; Kato, Yōkō; Sano, Hirotoshi

doi:10.1227/neu.0000000000002410

Cited by 5 publications

(1 citation statement)

References 31 publications

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“…33 In patients with sSAH, pupillary findings also enhance predictive accuracy. 34,35 The loss of pupillary reaction in sSAH generally occurs bilaterally due to global cerebral ischemia including the midbrain, where the oculomotor nuclei are located. In contrast, unilateral pupillary dilation is relatively uncommon and could be attributed to direct compression by an aneurysm or uncal herniation rather than global cerebral ischemia.…”

Section: Plasma D-dimer Levels Provide Valuable Insights Into Clinica...mentioning

confidence: 99%

High plasma D-dimer levels correlate with ictal infarction and poor outcomes in spontaneous subarachnoid hemorrhage

Kobata,

Sugie,

Tucker

et al. 2024

Preprint

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BACKGROUND: Early brain injury (EBI) is the leading cause of poor outcomes in patients with spontaneous subarachnoid hemorrhage (sSAH). Plasma D-dimer levels and acute cerebral ischemia have been highlighted as relevant findings in EBI; however, their correlation has not been substantially investigated. METHODS: This retrospective, single-center cohort study was conducted at a tertiary emergency medical center from January 2004 to June 2022. Consecutive patients with sSAH who presented within 12 h of SAH ictus and underwent magnetic resonance imaging within 3 days were included. We assessed the correlation of plasma D-dimer levels with acute ischemic lesions detected on the diffusion-weighted images (DWI) and the clinical characteristics of patients. RESULTS: Among 402 eligible patients (mean age, 63.5 years; 62.7% women; median time from onset to arrival, 45.5 min), 140 (34.8%) had acute ischemic lesions. Higher plasma D-dimer levels linearly correlated with worse neurological grades, more severe SAH on initial CT, acute ischemic lesions, and poor outcomes, except for patients with neurogenic stunned myocardium. In the multivariate analysis, acute ischemic lesions were significantly associated with worse neurological grades, higher plasma D-dimer levels, bilateral loss of light reaction, and advanced age. The receiver operating characteristic curve analysis showed D-dimer levels as excellent predictors for acute ischemic lesions (area under the curve [AUC], 0.897; cut-off value, 5.7 μg/mL, p <0.0001) and unfavorable outcomes (AUC, 0.786; cut-off value, 4.0 μg/mL, p <0.0001). CONCLUSIONS: High plasma D-dimer levels correlated with the appearance of acute ischemic lesions on DWI and were dose-dependently associated with worse neurological grades, more severe hemorrhage, and worse outcomes. Plasma D-dimer levels provide a valuable perspective on various issues in the acute phase of sSAH.

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Section: Plasma D-dimer Levels Provide Valuable Insights Into Clinica...mentioning

confidence: 99%

High plasma D-dimer levels correlate with ictal infarction and poor outcomes in spontaneous subarachnoid hemorrhage

Kobata,

Sugie,

Tucker

et al. 2024

Preprint

Self Cite

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Impact of ventriculo-cisternal irrigation on prevention of delayed cerebral infarction in aneurysmal subarachnoid hemorrhage: a single-center retrospective study and literature review

Umekawa,

Yoshikawa

2023

Neurosurg Rev

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Objective The aim of this study was to evaluate the effectiveness of ventriculo-cisternal irrigation (VCI) in preventing vasospasms and delayed cerebral infarction (DCI) by washing out subarachnoid clots earlier after aneurysm surgery. Methods We retrospectively identified 340 subarachnoid hemorrhage (SAH) patients with ruptured intracranial aneurysms treated with postoperative VCI at our institution between December 2010 and January 2020. As VCI therapy, a ventricular drain/cisternal drain was placed during aneurysm surgery, and lactated Ringer’s solution was used for irrigation until day 4 of SAH, followed by intracranial pressure control at 5–10 cmH2O until day 14. Results The median age was 65 years (interquartile range 52–75), with 236 female patients (69%). The World Federation of Neurosurgical Societies grade distribution was as follows: grade I or II, 175 patients (51%); grade III or IV, 84 (25%); and grade V, 81 (24%). With VCI management in all patients, total vasospasm occurred in 162 patients (48%), although the DCI incidence was low (23 patients [6.8%]). Major drainage-related complications were observed in five patients (1.5%). Early surgery, performed on SAH day 0 or 1, was identified as a preventive factor against DCI occurrence (odds ratio (OR) 0.21, 95% confidence interval (CI) 0.07–0.67; P = 0.008), while additional surgery (4.76, 1.62–13.98; P = 0.005) and dyslipidemia (3.27, 1.24–8.63; P = 0.017) were associated with DCI occurrence. Conclusion Managing vasospasms with VCI after SAH is considered a safe and effective method to prevent DCI. Early surgery after SAH may be associated with a decreased risk of DCI with VCI therapy.

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Incorporating Pupillary Findings into the Glasgow Coma Scale. Comment on: Significance of Pupillary Findings in Decision Making and Outcomes of World Federation of Neurological Surgeons Grade V Subarachnoid Hemorrhage

Kobata

Ikawa

Sato³

et al. 2023

World Neurosurgery

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Significance of Pupillary Findings in Decision Making and Outcomes of World Federation of Neurological Societies Grade V Subarachnoid Hemorrhage

Cited by 5 publications

References 31 publications

High plasma D-dimer levels correlate with ictal infarction and poor outcomes in spontaneous subarachnoid hemorrhage

High plasma D-dimer levels correlate with ictal infarction and poor outcomes in spontaneous subarachnoid hemorrhage

Impact of ventriculo-cisternal irrigation on prevention of delayed cerebral infarction in aneurysmal subarachnoid hemorrhage: a single-center retrospective study and literature review

Incorporating Pupillary Findings into the Glasgow Coma Scale. Comment on: Significance of Pupillary Findings in Decision Making and Outcomes of World Federation of Neurological Surgeons Grade V Subarachnoid Hemorrhage

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