The Subarachnoid Hemorrhage Early Brain Edema Score Predicts Delayed Cerebral Ischemia and Clinical Outcomes

Ahn, Sung‐Ho; Savarraj, Jude P.J.; Pervez, Mubashir; Jones, William E.; Park, Jin; Jeon, Sang-Beom; Kwon, Sun U.; Chang, Tiffany R.; Lee, Ki-Won; Kim, Dong H.; Day, Arthur L.; Choi, H. Alex

doi:10.1093/neuros/nyx364

Cited by 145 publications

(146 citation statements)

References 32 publications

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“…SEBES, which is considered an indicator of EBI, qualitatively assesses the degree of global cerebral edema after SAH. High‐grade SEBES is an indicator of an increased risk of developing DCI after hemorrhage . Another radiologic factor, “mFS,” based on quantifying the amount of blood quite possibly influences the degree of EBI and predicts CVS and DCI .…”

Section: Discussionmentioning

confidence: 99%

“…Large evidence proved higher mFS was a significant risk factor for DCI . Additionally, among the aSAH patients, a higher WFNS score at admission was considered a risk factor for DCI . The “WFNS” factor is derived from GCS score and focuses on signs and symptoms of SAH patients to reflect the primary brain injury at admission .…”

Section: Discussionmentioning

confidence: 99%

“…Poor clinical condition was defined as high WFNS (4‐5) and HH (4‐5). Radiological variables included intraventricular hemorrhage (IVH) and intra‐parenchymal hematoma on the initial CT scan, the mFS scale, and SEBES scale . Large amount of bleeding was defined as high mFS (3‐4); severe cerebral edema was defined as high SEBES (3‐4).…”

Section: Methodsmentioning

confidence: 99%

“…4 The incidence of DCI is influenced by several characteristics, including demographics (such as age, sex, personal history, and past medical history), 5 clinical status, and radiological changes at admission. 6,7 Previous studies have established several grading systems based on clinical or radiologic factors to predict incidence of DCI or outcome to guide treatment. 8 The Glasgow Coma Scale (GCS), Hunt-Hess (HH), and World Federation of Neurosurgical Societies (WFNS) are the widely used clinical grading scales, focusing on signs and symptoms to assess brain injury and prognosis; however, these grading systems do not take into account the volume and severity of bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…However, further studies are needed to determine the accuracy and effectiveness of this score. 7,10 The weakness of these radiological scales is underestimating the importance of the patients' clinical signs. Thus, some combined grading systems were promoted, such as VASOGRADE (VG) and the HAIR scale, to predict the outcome of aSAH patients.…”

Section: Introductionmentioning

confidence: 99%

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New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia

Fang

Mei

et al. 2019

CNS Neurosci Ther

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Background and Purpose The aim of this study is to identify the early predictors for delayed cerebral ischemia (DCI) and develop a risk stratification score by focusing on the early change after aneurysmal subarachnoid hemorrhage (aSAH). Methods The study retrospectively reviewed aSAH patients between 2014 and 2015. Risk factors within 72 hours after aSAH were included into univariable and multivariable logistic regression analysis to screen the independent predictors for DCI and to design a risk stratification score. Results We analyzed 702 aSAH patients; four predictors were retained from the final multivariable analysis: World Federation of Neurosurgical Societies scale (WFNS; OR = 4.057, P < .001), modified Fisher Scale (mFS; OR = 2.623, P < .001), Subarachnoid Hemorrhage Early Brain Edema Score (SEBES; OR = 1.539, P = .036), and intraventricular hemorrhage (IVH; OR = 1.932, P = .002). According to the regression coefficient, we created a risk stratification score ranging from 0 to 7 (WFNS = 3, mFS = 2, SEBES = 1, and IVH = 1). The new score showed a significantly higher area under curve (0.785) compared with other scores (P < .001). Conclusion The early DCI score provides a practical method at the early 72 hours after aSAH to predict DCI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia

Fang

Mei

et al. 2019

CNS Neurosci Ther

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Tenascin‐C in brain injuries and edema after subarachnoid hemorrhage: Findings from basic and clinical studies

Suzuki

Fujimoto

Kawakita

et al. 2018

J of Neuroscience Research

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Subarachnoid hemorrhage (SAH) by a rupture of cerebral aneurysms remains the most devastating cerebrovascular disease. Early brain injury (EBI) is increasingly recognized to be the primary determinant for poor outcomes, and also considered to cause delayed cerebral ischemia (DCI) after SAH. Both clinical and experimental literatures emphasize the impact of global cerebral edema in EBI as negative prognostic and direct pathological factors. The nature of the global cerebral edema is a mixture of cytotoxic and vasogenic edema, both of which may be caused by post‐SAH induction of tenascin‐C (TNC) that is an inducible, non‐structural, secreted and multifunctional matricellular protein. Experimental SAH induces TNC in brain parenchyma in rats and mice. TNC knockout suppressed EBI in terms of brain edema, blood‐brain barrier disruption, neuronal apoptosis and neuroinflammation, associated with the inhibition of post‐SAH activation of mitogen‐activated protein kinases and nuclear factor‐kappa B in mice. In a clinical setting, more severe SAH increases more TNC in cerebrospinal fluid and peripheral blood, which could be a surrogate marker of EBI and predict DCI development and outcomes. In addition, cilostazol, a selective inhibitor of phosphodiesterase type III that is a clinically available anti‐platelet agent and is known to suppress TNC induction, dose‐dependently inhibited delayed cerebral infarction and improved outcomes in a pilot clinical study. Thus, further studies may facilitate application of TNC as biomarkers for non‐invasive diagnosis or assessment of EBI and DCI, and lead to development of a molecular target drug against TNC, contributing to the improvement of post‐SAH outcomes.

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Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist

Robba,

Busl,

Claassen

et al. 2024

Intensive Care Med

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Aneurysmal subarachnoid haemorrhage (aSAH) is a rare yet profoundly debilitating condition associated with high global case fatality and morbidity rates. The key determinants of functional outcome include early brain injury, rebleeding of the ruptured aneurysm and delayed cerebral ischaemia. The only effective way to reduce the risk of rebleeding is to secure the ruptured aneurysm quickly. Prompt diagnosis, transfer to specialized centers, and meticulous management in the intensive care unit (ICU) significantly improved the prognosis of aSAH. Recently, multimodality monitoring with specific interventions to correct pathophysiological imbalances has been proposed. Vigilance extends beyond intracranial concerns to encompass systemic respiratory and haemodynamic monitoring, as derangements in these systems can precipitate secondary brain damage. Challenges persist in treating aSAH patients, exacerbated by a paucity of robust clinical evidence, with many interventions showing no benefit when tested in rigorous clinical trials. Given the growing body of literature in this field and the issuance of contemporary guidelines, our objective is to furnish an updated review of essential principles of ICU management for this patient population. Our review will discuss the epidemiology, initial stabilization, treatment strategies, long-term prognostic factors, the identification and management of post-aSAH complications. We aim to offer practical clinical guidance to intensivists, grounded in current evidence and expert clinical experience, while adhering to a concise format. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-024-07387-7.

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The Subarachnoid Hemorrhage Early Brain Edema Score Predicts Delayed Cerebral Ischemia and Clinical Outcomes

Abstract: SEBES may be a surrogate marker of EBI and predicts DCI and clinical outcomes after SAH.

Cited by 145 publications

References 32 publications

New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia

New risk score of the early period after spontaneous subarachnoid hemorrhage: For the prediction of delayed cerebral ischemia

Tenascin‐C in brain injuries and edema after subarachnoid hemorrhage: Findings from basic and clinical studies

Contemporary management of aneurysmal subarachnoid haemorrhage. An update for the intensivist

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