The spontaneous arterial blood pressure rise after aneurysmal subarachnoid hemorrhage – A biphasic phenomenon

Fontana, Johann; Scharf, Johann; Weiß, Christel; Schmieder, Kirsten; Barth, Martin

doi:10.1016/j.clineuro.2015.06.014

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…SAH is known to lead to spontaneous and progressive elevations in mean arterial blood pressure, which could affect CTP parameters. [ 5 ] Furthermore, changes in systemic hemodynamics may not be adequately compensated for by cerebral autoregulation impairment by focal vasospasm at the contralateral side. [ 20 ] That is why four values were obtained from the ROI and averaged as the contralateral non-vasospastic region for reduction of these biases in the present study.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Omoto¹,

Nakagawa²,

Nishimura³

et al. 2020

Surgical Neurology International

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Background: Endovascular treatment (ET) can improve angiographic cerebral vasospasm (CV) after aneurysmal subarachnoid hemorrhage, but was unrelated to clinical outcomes in previous analyses. Appropriate detection of CV and precise indications for ET are required. This study investigated whether changes in computed tomography perfusion (CTP) parameter can determine indications for ET in CV and predict its effectiveness. Methods: Participants comprised 140 patients who underwent neck clipping or coil embolization. CTP was performed a week after aneurysmal treatment or when clinical deterioration had occurred. Patients were divided into ET and non-ET groups by propensity score matching. In addition, the ET group was divided into subgroups with and without new cerebral infarction (CI). All CTP images in the three groups were retrospectively investigated qualitatively and quantitatively. CI was diagnosed from CT at 3 months postoperatively. Results: Of the 121 patients examined, 15 patients (11%) needed ET. In qualitative analysis, all ET group patients displayed extension of time-to-peak (TTP) at the region of vasospastic change, regardless of the presence of CI. Quantitative analysis showed significant decreases in cerebral blood volume (P < 0.01), cerebral blood flow (CBF) (P < 0.001), and extension in TTP (P < 0.01) in the ET group compared with the non-ET group. A significant decrease in CBF (P < 0.001) and extension in mean transit time (P < 0.001) was seen in the ET with CI subgroup compared with the ET without CI subgroup. Conclusion: CTP in the vasospastic period may be an indication for ET and predict the effectiveness of ET for CV to improve clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Omoto¹,

Nakagawa²,

Nishimura³

et al. 2020

Surgical Neurology International

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“…Changes of systemic hemodynamic parameters in patients after aSAH in parallel to evolving cerebral vasospasms are a well-known phenomenon 28,29 . Typically, an increase of systemic blood pressure can be observed, which is more pronounced in patients with more severe cerebral vasospasms 28 .…”

Section: Discussionmentioning

confidence: 99%

Repetitive Computed Tomography Perfusion for Detection of Cerebral Vasospasm–Related Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage

et al. 2019

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Background: Delayed cerebral infarction after aneurysmal subarachnoid hemorrhage (aSAH) still remains the leading cause of disability in patients that survive the initial ictus. It has been shown that CT perfusion (CTP) imaging can detect hypoperfused brain areas. The aim of this study was to evaluate if a single acute CTP examination at time of neurological deterioration is sufficient or if an additional baseline CTP increases diagnostic accuracy. Methods: Retrospective analysis of acute and baseline (within 24 hours after aneurysm treatment) CTP examinations of patients with neurological deterioration because of vasospasm-related hypoperfusion. Patients without clinical deterioration during the vasospasm period served as controls. The following CTP parameters were analyzed for predefined brain regions: time to drain (TTD), mean transit time, time to peak, cerebral blood flow and volume. Results: 33 patients with and 23 without neurological deterioration were included. Baseline CTP examination did not ameliorate diagnostic accuracy of the acute CTP examination in symptomatic patients. The same was true for inter-hemispheric comparison of perfusion parameters of the acute examination. The CTP parameter with the highest diagnostic yield was TTD of the symptomatic brain region (threshold value 4.7 sec, sensitivities 97 %, specificities 96 %). Conclusions: Acute CTP examination in case of suspected vasospasm-induced neurological deterioration after aSAH has the highest diagnostic accuracy to detect misery perfusion.

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“…Nach Subarachnoidalblutung steigen die Blutdruckwerte in den ersten 5 Tagen oft an, und zwar stärker bei Patienten mit Vasospasmen [48]. Wahrscheinlich steigt die Reblutungsrate unversorgter cerebraler Aneurysmen bei systolischen Blutdruckwerten über 160 mmHg [49].…”

Section: Subarachnoidalblutung Und Blutdrucksenkungunclassified

Hypertensive Krise und posteriores reversibles Enzephalopathie-Syndrom (PRES)

Eberhardt

2018

Fortschr Neurol Psychiatr

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The urgency and intensity of therapeutic response to a hypertensive crisis are governed by the presence or absence of acute end-organ damage, which define hypertensive emergency and hypertensive urgency, respectively. In case of hypertensive urgency a slow and moderate lowering of blood pressure by oral antihypertensive agents seems adequate, while the approach to hypertensive emergency has to be tailored to the specific type of organ failure. Optimal blood pressure management in the context of neurovascular emergencies is made difficult by contradictory data from observational and interventional studies. It might prove advantageous to individualize treatment according to characteristics such as the location of persistent vessel occlusion or the presence of collaterals. Reversible posterior encephalopathy may present with atypical features that might make diagnosis difficult. Clevidipine might be a welcome supplement to current intravenous antihypertensive agents in neurological disease.

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The spontaneous arterial blood pressure rise after aneurysmal subarachnoid hemorrhage – A biphasic phenomenon

Cited by 7 publications

References 24 publications

Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Computed tomography perfusion imaging after aneurysmal subarachnoid hemorrhage can detect cerebral vasospasm and predict delayed cerebral ischemia after endovascular treatment

Repetitive Computed Tomography Perfusion for Detection of Cerebral Vasospasm–Related Hypoperfusion in Aneurysmal Subarachnoid Hemorrhage

Hypertensive Krise und posteriores reversibles Enzephalopathie-Syndrom (PRES)

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