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Subject Area

Neuropsychiatry

Article Type

Original Study

Abstract

Objectives To assess computed tomography (CT) blood clot thickness, aneurysmal site and size as predictors for vasospasm after subarachnoid hemorrhage (SAH). Background Cerebral vasospasm and delayed cerebral ischemia are common factors of poor outcome following SAH. Patients and methods Forty patients with acute aneurysmal SAH. Outcome was assessed clinically by Glasgow coma scale, Hunt and Hess scale, radiologically by cerebral CT [modified Fisher's scale (MFS)], cerebral CT angiography, and transcranial Doppler (follow-up on the first, third, fifth, seventh, and tenth day from SAH onset) for the appearance of vasospasm. Results There is no significant difference between the amount of blood detected by CT (MFS) and cerebral aneurysm sites as U = 0.513, P = 0.972. Early vasospasm was detected in 13 cases in middle cerebral artery, seven cases anterior communicating, four posterior communicating, and the least was internal carotid and posterior cerebral (two cases and one case, respectively). Univariate logistic regression and receiver-operating characteristic curve showed that the predictors for vasospasm were systolic and diastolic blood pressure (DBP) (systolic blood pressure with diagnostic accuracy = area under the curve=[95% confidence interval (CI)=0.82, P = 0.0001, cutoff point >195 and DBP: 95% CI = 0.87, P = 0.0001, cutoff point >95 for DBP], hemoglobin A1C (95% CI = 0.89, P = 0.0001, cutoff point >7), Glasgow coma scale (95% CI = 0.80, P = 0.001, cutoff point <14), Hunt and Hess scale (95% CI = 0.80, P = 0.001, cutoff point >2), MFS (95% CI = 0.70, P = 0.045, cutoff point >1) and aneurysmal size (95% CI = 0.77, P = 0.0003, cutoff point >7) but aneurysmal site and smoking P = 0.995 and 0.99, respectively were not predictors in spite of association. Conclusion Clinical severity of SAH, blood clot thickness, aneurysmal size, systolic blood pressure and DBP, and glycated hemoglobin seem to be important predictors for cerebral vasospasm after SAH.

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