Global Cerebral Edema After Subarachnoid Hemorrhage
Top Cited Papers
- 1 May 2002
- journal article
- Published by Wolters Kluwer Health in Stroke
- Vol. 33 (5) , 1225-1232
- https://doi.org/10.1161/01.str.0000015624.29071.1f
Abstract
Cerebral edema visualized by CT is often seen after subarachnoid hemorrhage (SAH). Inflammatory or circulatory mechanisms have been postulated to explain this radiographic observation after SAH. We sought to determine the frequency, causes, and impact on outcome of early and delayed global cerebral edema after SAH. We evaluated the presence of global edema on admission and follow-up CT scans in 374 SAH patients admitted within 5 days of onset to our Neurological Intensive Care Unit between July 1996 and February 2001. Using multivariate analysis, we identified predictors of global cerebral edema and evaluated the impact of global edema on outcome 3 months after onset with the modified Rankin Scale. Global edema was present on admission CT scans in 8% (n=29) and developed secondarily in 12% (n=44) of the patients. Global edema on admission was predicted by loss of consciousness at ictus and increasing Hunt-Hess grade. Delayed global edema was predicted by aneurysm size >10 mm, loss of consciousness at ictus, use of vasopressors, and increased SAH sum scores. Thirty-seven percent (n=137) of the patients were dead or severely disabled (modified Rankin Scale 4 to 6) at 3 months. Death or severe disability was predicted by any global edema, aneurysm size >10 mm, loss of consciousness at ictus, increased National Institutes of Health Stroke Scale scores, and older age. Global edema is an independent risk factor for mortality and poor outcome after SAH. Loss of consciousness, which may reflect ictal cerebral circulatory arrest, is a risk factor for admission global edema, and vasopressor-induced hypertension is associated with the development of delayed global edema. Critical care management strategies that minimize edema formation after SAH may improve outcome.Keywords
This publication has 22 references indexed in Scilit:
- Autoregulatory Vasodilation of Parenchymal Vessels is Impaired during Cerebral VasospasmJournal of Cerebral Blood Flow & Metabolism, 1998
- Edema from intracerebral hemorrhage: the role of thrombinJournal of Neurosurgery, 1996
- Impaired capillary perfusion and brain edema following experimental subarachnoid hemorrhage: a morphometric studyJournal of Neurosurgery, 1990
- Altered Cerebral Autoregulation and CO2 Reactivity after Aneurysmal Subarachnoid HemorrhageNeurosurgery, 1988
- The Critical First Minutes after Subarachnoid HemorrhageNeurosurgery, 1988
- APACHE IICritical Care Medicine, 1985
- Acute hydrocephalus after aneurysmal subarachnoid hemorrhageJournal of Neurosurgery, 1985
- Cerebrovascular reactivity in patients with ruptured intracranial aneurysmsJournal of Neurosurgery, 1985
- An experimental study of acute subarachnoid haemorrhage in baboons: changes in cerebral blood volume, blood flow, electrical activity and water content.Journal of Neurology, Neurosurgery & Psychiatry, 1984
- An experimental study of the acute stage of subarachnoid hemorrhageJournal of Neurosurgery, 1983