Subarachnoid Hemorrhage in the Subacute Stage: Elevated Apparent Diffusion Coefficient in Normal-appearing Brain Tissue after Treatment

Liu, Yawu; Soppi, Ville; Mustonen, Timo; Könönen, Mervi; Koivisto, Timo; Koskela, Anna; Rinne, Jaakko; Vanninen, Ritva

doi:10.1148/radiol.2422051698

Cited by 38 publications

(40 citation statements)

References 24 publications

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“…These changes were attributed to acute vasospasm, related to the affected arterial territory. Another study that analysed ADC values in the subacute stage of SAH [13], in comparison to normal controls, found a global increase in ADC values affecting both white and grey matter. This seems to contradict our results, but there are fundamental differences in study design that might explain this discrepancy in findings, as no measurements of the internal capsule were taken, and patients with vasospasm were excluded.…”

Section: Discussionmentioning

confidence: 99%

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Evolution of diffusion tensor imaging parameters after acute subarachnoid haemorrhage: a prospective cohort study

et al. 2016

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Introduction Few studies assessed diffusion tensor imaging (DTI) changes in the acute phase of subarachnoid haemorrhage (SAH). We prospectively evaluated DTI parameters in the acute phase of SAH and 8-10 days after and analysed whether changes could be related to SAH severity or to the development of delayed cerebral ischemia (DCI). Methods Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) changes over time were assessed in a prospective cohort of patients with acute SAH. Two MRI studies were performed at <72 h (MRI-1) and 8-10 days (MRI-2). DTI parameters were recorded in 15 ROIs. Linear mixed regression models were used.

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Section: Discussionmentioning

confidence: 99%

“…It is known, for instance, that ADC values are affected in white matter not only in the acute [12] but also in the subacute phase of SAH [13].…”

Section: Background and Purposementioning

confidence: 99%

Evolution of diffusion tensor imaging parameters after acute subarachnoid haemorrhage: a prospective cohort study

et al. 2016

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“…Thus, in our sample, the probability of patients with DCV having a favorable or a poor outcome was nearly the same. Because brain edema may occur at the onset of SAH and is accompanied by taurine release, 1,3,8,9 we analyzed the plasma concentration of this amino acid, looking for an association with patient outcomes. Compared with levels in controls, admission taurine concentrations were increased (2-fold) in SAH patients with a favorable outcome, but they were further increased (6-fold) in SAH patients with a poor outcome at discharge (Fig.…”

Section: Discussionmentioning

confidence: 99%

“…This dysfunction begins to develop immediately after ictus, but it may not be detected by routine imaging methods. 3,8,9 After SAH, a global reduction in cerebral perfusion due to early vasoconstriction of the microvasculature and increased intracranial pressure due to the volume effect of extravascular blood are thought to result in cerebral ischemia and blood-brain barrier disruption with a consecutive increase in cerebral water content. 14,17,21 This finding is important because brain edema is associated with a poor outcome in SAH; therefore, preventing this complication could improve patient recovery.…”

Section: Discussionmentioning

confidence: 99%

“…22 Brain edema also occurs in SAH and may influence patient outcome, although it may not be detected by routine imaging methods. 3,8,9 Astrocytic swelling has been implicated in the pathophysiology of this complication. 1 To maintain cell volume, astrocytes take up or release organic osmolytes, such as taurine, 1 which is present in the brain.…”

confidence: 99%

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Plasma taurine as a predictor of poor outcome in patients with mild neurological deficits after aneurysmal subarachnoid hemorrhage

Coll¹,

Pérez-Neri

Avendaño³

et al. 2013

JNS

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Object. The object of this study was to determine the relationship between plasma taurine and subarachnoid hemorrhage (SAH) outcome.Methods. Forty patients with SAH and mild neurological deficits were included in this prospective, blinded cohort study. Plasma taurine levels were measured using high-performance liquid chromatography on admission and were correlated with patient outcomes at discharge.Results. Twenty-five percent of the patients ultimately had a poor outcome. Plasma taurine concentrations at admission were increased (2-fold) in SAH patients with a favorable outcome and were further increased (6-fold) in those who had a poor outcome. Increased taurine levels identified patients who would be discharged with a poor outcome, with sensitivity and specificity values of approximately 80% and 100%, respectively, and positive and negative predictive values of approximately 90%. Delayed cerebral vasospasm showed an OR of 27.9 (95% CI 1.090-714.9) for a poor outcome, whereas an increased taurine concentration had an OR of 105 for a poor outcome (95% CI 8.3-1328.0, p < 0.001).Conclusions. Increased plasma taurine concentrations on admission predict a poor outcome in SAH. J. Barges-Coll et al. 1022J Neurosurg / Volume 119 / October 2013 come predictor for Grades IV and V, but patients with a mild neurological deficit may unexpectedly have a poor outcome. 22 Up to 55% of patients with Fisher Grades 2 or 3 may have a poor outcome. 10,20 It is possible that the plasma taurine concentration may be elevated from the onset of SAH and may be associated with patient outcome, reflecting possible brain edema and explaining the unexpectedly poor outcome of patients with a mild neurological deficit after SAH. 17 Methods Study ParticipantsIn this prospective, blinded cohort study, approved by our institutional review board, we considered 211 consecutive patients who were admitted to the Emergency Department of our institute under the suspected diagnosis of a ruptured aneurysm (Fig. 1). Among these patients, only 41 fulfilled our study inclusion criteria: admission within the first 24 hours after SAH onset, HH Grade I-II, WFNS Grade I-II, 8 hours of fasting, not referred from another hospital, taking no medication during the previous 8 hours, and willingness to participate in the study and sign informed consent. One patient was excluded from the final analysis since taurine analysis was inconclusive. Data pertaining to demographic factors, comorbidities, Glasgow Coma Scale score, and HH grade were recorded on admission to the Emergency Department. Eighteen healthy volunteers were recruited as the control group.Routine blood analyses were performed (complete blood count, glucose, electrolytes, partial thromboplastin time, international normalized ratio). All patients underwent a 4-vessel digital angiography and CT study for the diagnosis of a ruptured aneurysm. Sample ProcessingA 20-ml blood sample was taken from every patient upon admission to the Emergency Department. Samples were labeled with a serial number and taken t...

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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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Subarachnoid Hemorrhage in the Subacute Stage: Elevated Apparent Diffusion Coefficient in Normal-appearing Brain Tissue after Treatment

Abstract: SAH and its treatment may cause global mild vasogenic edema in white matter and deep gray matter that is undetectable on T2-weighted and diffusion-weighted MR images but is detectable by measuring the ADC value in the subacute stage of SAH.

Cited by 38 publications

References 24 publications

Evolution of diffusion tensor imaging parameters after acute subarachnoid haemorrhage: a prospective cohort study

Evolution of diffusion tensor imaging parameters after acute subarachnoid haemorrhage: a prospective cohort study

Plasma taurine as a predictor of poor outcome in patients with mild neurological deficits after aneurysmal subarachnoid hemorrhage

Imaging the future of stroke: II. Hemorrhage

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