Galbraith Award 133 Bilateral Failure of Cerebral Autoregulation is Related to Unfavorable Outcome After Subarachnoid Hemorrhage
Abstract INTRODUCTION: The extent of hemodynamic disturbances following subarachnoid hemorrhage (SAH) varies. We aim to determine the prognostic implications of unilateral and bilateral autoregulatory failure on delayed cerebral ischemia (DCI) and outcome. METHODS: Ninety-eight patients with aneurys...
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| Veröffentlicht in: | Neurosurgery 2014-08, Vol.61 (CN_suppl_1), p.203-203 |
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| creator | Budohoski, Karol P. Kirkpatrick, Peter J. Smielewski, Peter Reinhard, Matthias Varsos, Georgios V. Kasprowicz, Magdalena Zabek, Miroslaw Pickard, John Douglas Czosnyka, Marek |
| description | Abstract
INTRODUCTION:
The extent of hemodynamic disturbances following subarachnoid hemorrhage (SAH) varies. We aim to determine the prognostic implications of unilateral and bilateral autoregulatory failure on delayed cerebral ischemia (DCI) and outcome.
METHODS:
Ninety-eight patients with aneurysmal SAH were recruited. Autoregulation was assessed using systolic flow index Sxa. Interhemispheric difference was calculated. Patients were dichotomized by presence of DCI and 3-month outcome using the mRS.
RESULTS:
Higher flow velocity (FV) and worse autoregulation (P < .0000001; 95% confidence interval [CI]: 10.7-21.3; and P = .00001; 95% CI: 0.03-0.07 for difference in FV and Sxa, respectively) were found in the ipsilateral hemisphere. The DCI group had a higher interhemispheric difference of autoregulation than the non-DCI group (P = .0004; 95% CI: 0.03-0.09). 16/18 patients with unfavorable outcome had poor autoregulation with low interhemispheric differences vs 17/72 patients with favorable outcome (P = .0013 χ2). Unilateral autoregulatory failure was seen on a median day 3, bilateral on day 4, and vasospasm was detected on day 6. Unilateral autoregulation failure was seen in patients who developed DCI (worse ipsilateral to the ischemic hemisphere).
CONCLUSION:
Bilateral autoregulation failure was seen more frequently in patients with unfavorable outcome. Analysis of the temporal profile showed unilateral dysautoregulation as the primary predisposing to DCI, and in selected cases leads to bilateral failure and unfavorable outcomes. |
| doi_str_mv | 10.1227/01.neu.0000452407.30581.d4 |
| format | Article |
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INTRODUCTION:
The extent of hemodynamic disturbances following subarachnoid hemorrhage (SAH) varies. We aim to determine the prognostic implications of unilateral and bilateral autoregulatory failure on delayed cerebral ischemia (DCI) and outcome.
METHODS:
Ninety-eight patients with aneurysmal SAH were recruited. Autoregulation was assessed using systolic flow index Sxa. Interhemispheric difference was calculated. Patients were dichotomized by presence of DCI and 3-month outcome using the mRS.
RESULTS:
Higher flow velocity (FV) and worse autoregulation (P < .0000001; 95% confidence interval [CI]: 10.7-21.3; and P = .00001; 95% CI: 0.03-0.07 for difference in FV and Sxa, respectively) were found in the ipsilateral hemisphere. The DCI group had a higher interhemispheric difference of autoregulation than the non-DCI group (P = .0004; 95% CI: 0.03-0.09). 16/18 patients with unfavorable outcome had poor autoregulation with low interhemispheric differences vs 17/72 patients with favorable outcome (P = .0013 χ2). Unilateral autoregulatory failure was seen on a median day 3, bilateral on day 4, and vasospasm was detected on day 6. Unilateral autoregulation failure was seen in patients who developed DCI (worse ipsilateral to the ischemic hemisphere).
CONCLUSION:
Bilateral autoregulation failure was seen more frequently in patients with unfavorable outcome. Analysis of the temporal profile showed unilateral dysautoregulation as the primary predisposing to DCI, and in selected cases leads to bilateral failure and unfavorable outcomes.</description><identifier>ISSN: 0148-396X</identifier><identifier>EISSN: 1524-4040</identifier><identifier>DOI: 10.1227/01.neu.0000452407.30581.d4</identifier><language>eng</language><publisher>Philadelphia: Oxford University Press</publisher><subject>Flow velocity ; Hemodynamics ; Neurosurgery ; Stroke</subject><ispartof>Neurosurgery, 2014-08, Vol.61 (CN_suppl_1), p.203-203</ispartof><rights>Copyright © 2014 by the Congress of Neurological Surgeons</rights><rights>Copyright © by the Congress of Neurological Surgeons</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids></links><search><creatorcontrib>Budohoski, Karol P.</creatorcontrib><creatorcontrib>Kirkpatrick, Peter J.</creatorcontrib><creatorcontrib>Smielewski, Peter</creatorcontrib><creatorcontrib>Reinhard, Matthias</creatorcontrib><creatorcontrib>Varsos, Georgios V.</creatorcontrib><creatorcontrib>Kasprowicz, Magdalena</creatorcontrib><creatorcontrib>Zabek, Miroslaw</creatorcontrib><creatorcontrib>Pickard, John Douglas</creatorcontrib><creatorcontrib>Czosnyka, Marek</creatorcontrib><title>Galbraith Award 133 Bilateral Failure of Cerebral Autoregulation is Related to Unfavorable Outcome After Subarachnoid Hemorrhage</title><title>Neurosurgery</title><description>Abstract
INTRODUCTION:
The extent of hemodynamic disturbances following subarachnoid hemorrhage (SAH) varies. We aim to determine the prognostic implications of unilateral and bilateral autoregulatory failure on delayed cerebral ischemia (DCI) and outcome.
METHODS:
Ninety-eight patients with aneurysmal SAH were recruited. Autoregulation was assessed using systolic flow index Sxa. Interhemispheric difference was calculated. Patients were dichotomized by presence of DCI and 3-month outcome using the mRS.
RESULTS:
Higher flow velocity (FV) and worse autoregulation (P < .0000001; 95% confidence interval [CI]: 10.7-21.3; and P = .00001; 95% CI: 0.03-0.07 for difference in FV and Sxa, respectively) were found in the ipsilateral hemisphere. The DCI group had a higher interhemispheric difference of autoregulation than the non-DCI group (P = .0004; 95% CI: 0.03-0.09). 16/18 patients with unfavorable outcome had poor autoregulation with low interhemispheric differences vs 17/72 patients with favorable outcome (P = .0013 χ2). Unilateral autoregulatory failure was seen on a median day 3, bilateral on day 4, and vasospasm was detected on day 6. Unilateral autoregulation failure was seen in patients who developed DCI (worse ipsilateral to the ischemic hemisphere).
CONCLUSION:
Bilateral autoregulation failure was seen more frequently in patients with unfavorable outcome. Analysis of the temporal profile showed unilateral dysautoregulation as the primary predisposing to DCI, and in selected cases leads to bilateral failure and unfavorable outcomes.</description><subject>Flow velocity</subject><subject>Hemodynamics</subject><subject>Neurosurgery</subject><subject>Stroke</subject><issn>0148-396X</issn><issn>1524-4040</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqVkc9q3DAQxkVpodu07yCas139s63tbbM0SSEQSFLoTYytUexUa21lK0tuJXnTPkm02ULPmcvAx_ebYb4h5DNnJRei-cJ4OWIqWS5VCcWaUrJK89KqN2TBs1IopthbsmBc6UIu65_vyYdpumOM16rRC_J4Br6NMMw9Xe0gWsql_Pvn6WTwMGMET09h8CkiDY6uMWK711ZpDhFvU_YMYaTDRK9w77d0DvTH6OA-RGg90ss0d2GDdOXyMHqdWojQ9WMYLD3HTYixh1v8SN458BN--tePyM3pt5v1eXFxefZ9vbooOiGELLgWulF1zRqpgS1dKxQIXVmFsgbZ6sZai1i1nVIMuOZaua4DZZdOO8creUSOD2O3MfxOOM3mLqQ45o1GKMmZqJZ1k11fD64uhmmK6Mw2DhuID4Yzs4_cMG5y5OZ_5OYlcmNVhtUB3gWfD55--bTDaHoEP_cvRM3zJSI_g-n8giIrjcxYdcBC2r5m3TPPMJc8</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Budohoski, Karol P.</creator><creator>Kirkpatrick, Peter J.</creator><creator>Smielewski, Peter</creator><creator>Reinhard, Matthias</creator><creator>Varsos, Georgios V.</creator><creator>Kasprowicz, Magdalena</creator><creator>Zabek, Miroslaw</creator><creator>Pickard, John Douglas</creator><creator>Czosnyka, Marek</creator><general>Oxford University Press</general><general>Copyright by the Congress of Neurological Surgeons</general><general>Wolters Kluwer Health, Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20140801</creationdate><title>Galbraith Award 133 Bilateral Failure of Cerebral Autoregulation is Related to Unfavorable Outcome After Subarachnoid Hemorrhage</title><author>Budohoski, Karol P. ; Kirkpatrick, Peter J. ; Smielewski, Peter ; Reinhard, Matthias ; Varsos, Georgios V. ; Kasprowicz, Magdalena ; Zabek, Miroslaw ; Pickard, John Douglas ; Czosnyka, Marek</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2223-182874660738a09fb24a285d4e36a3b87dddee5bc440a18184fcca4d9f8ff153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Flow velocity</topic><topic>Hemodynamics</topic><topic>Neurosurgery</topic><topic>Stroke</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Budohoski, Karol P.</creatorcontrib><creatorcontrib>Kirkpatrick, Peter J.</creatorcontrib><creatorcontrib>Smielewski, Peter</creatorcontrib><creatorcontrib>Reinhard, Matthias</creatorcontrib><creatorcontrib>Varsos, Georgios V.</creatorcontrib><creatorcontrib>Kasprowicz, Magdalena</creatorcontrib><creatorcontrib>Zabek, Miroslaw</creatorcontrib><creatorcontrib>Pickard, John Douglas</creatorcontrib><creatorcontrib>Czosnyka, Marek</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Neurosurgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Budohoski, Karol P.</au><au>Kirkpatrick, Peter J.</au><au>Smielewski, Peter</au><au>Reinhard, Matthias</au><au>Varsos, Georgios V.</au><au>Kasprowicz, Magdalena</au><au>Zabek, Miroslaw</au><au>Pickard, John Douglas</au><au>Czosnyka, Marek</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Galbraith Award 133 Bilateral Failure of Cerebral Autoregulation is Related to Unfavorable Outcome After Subarachnoid Hemorrhage</atitle><jtitle>Neurosurgery</jtitle><date>2014-08-01</date><risdate>2014</risdate><volume>61</volume><issue>CN_suppl_1</issue><spage>203</spage><epage>203</epage><pages>203-203</pages><issn>0148-396X</issn><eissn>1524-4040</eissn><abstract>Abstract
INTRODUCTION:
The extent of hemodynamic disturbances following subarachnoid hemorrhage (SAH) varies. We aim to determine the prognostic implications of unilateral and bilateral autoregulatory failure on delayed cerebral ischemia (DCI) and outcome.
METHODS:
Ninety-eight patients with aneurysmal SAH were recruited. Autoregulation was assessed using systolic flow index Sxa. Interhemispheric difference was calculated. Patients were dichotomized by presence of DCI and 3-month outcome using the mRS.
RESULTS:
Higher flow velocity (FV) and worse autoregulation (P < .0000001; 95% confidence interval [CI]: 10.7-21.3; and P = .00001; 95% CI: 0.03-0.07 for difference in FV and Sxa, respectively) were found in the ipsilateral hemisphere. The DCI group had a higher interhemispheric difference of autoregulation than the non-DCI group (P = .0004; 95% CI: 0.03-0.09). 16/18 patients with unfavorable outcome had poor autoregulation with low interhemispheric differences vs 17/72 patients with favorable outcome (P = .0013 χ2). Unilateral autoregulatory failure was seen on a median day 3, bilateral on day 4, and vasospasm was detected on day 6. Unilateral autoregulation failure was seen in patients who developed DCI (worse ipsilateral to the ischemic hemisphere).
CONCLUSION:
Bilateral autoregulation failure was seen more frequently in patients with unfavorable outcome. Analysis of the temporal profile showed unilateral dysautoregulation as the primary predisposing to DCI, and in selected cases leads to bilateral failure and unfavorable outcomes.</abstract><cop>Philadelphia</cop><pub>Oxford University Press</pub><doi>10.1227/01.neu.0000452407.30581.d4</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Flow velocity Hemodynamics Neurosurgery Stroke |
| title | Galbraith Award 133 Bilateral Failure of Cerebral Autoregulation is Related to Unfavorable Outcome After Subarachnoid Hemorrhage |
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