RESUMEN
BACKGROUND: Cerebrovascular disease is the fifth cause of mortality in Puerto Rico. There is no descriptive study for the presentation of spontaneous subarachnoid hemorrhage (SAH) in our institution. Therefore, our primary aim was to perform a retrospective analysis of adult patients with spontaneous SAH and assess the need for digital subtraction angiography (DSA) after initially aneurysm-negative computed tomography angiography (CTA) in nonaneurysmal SAH, specifically perimesencephalic SAH (PM-SAH). METHODS: Medical records of 324 adult patients with aneurysmal and nonaneurysmal SAH treated at the Puerto Rico Medical Center from 2015 to 2018 were retrospectively analyzed. Demographics, past medical history, clinical characteristics, and imaging information were extracted. RESULTS: Acute hydrocephalus, mortality at 30 days, prevalence of diffuse SAH pattern, and Fisher and World Federation of Neurosurgical Societies grades >2 on initial examination were higher in the aneurysmal SAH subgroup. Patients with nonaneurysmal SAH had a significantly higher prevalence of chronic kidney disease and diabetes mellitus. Of the patients with nonaneurysmal PM-SAH with initial aneurysm-negative CTA, 100% were subsequently confirmed by DSA. CONCLUSIONS: Patients in the aneurysmal SAH subgroup correlated with an increased disease burden. Furthermore, this study shows that in our population, patients with nonaneurysmal PM-SAH with a low Fisher and World Federation of Neurosurgical Societies grade and with comorbid diabetes mellitus and chronic kidney disease may not need DSA after a negative initial CTA result.
Asunto(s)
Angiografía de Substracción Digital/métodos , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/epidemiología , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/epidemiología , Anciano , Diabetes Mellitus/diagnóstico por imagen , Diabetes Mellitus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Puerto Rico/epidemiología , Insuficiencia Renal Crónica/diagnóstico por imagen , Insuficiencia Renal Crónica/epidemiología , Estudios Retrospectivos , Espacio Subaracnoideo/diagnóstico por imagenRESUMEN
BACKGROUND: To determine the clinical outcomes of perimesencephalic subarachnoid hemorrhages based on the computed tomography (CT) bleeding patterns. METHODS: This retrospective cohort study included: (1) patients (≥18 years) admitted to a comprehensive stroke center (January 2015-May 2018), (2) with angiography-negative, nontraumatic subarachnoid hemorrhage in a perimesencephalic or diffuse bleeding pattern, and (3) had CT imaging performed in ≤ 72 hours of symptom onset. Patients were stratified by location of bleeding on CT: Peri-1: focal prepontine hemorrhage; Peri-2: prepontine with suprasellar cistern +/- intraventricular extension; and diffuse. RESULTS: Of the 39 patients included, 13 were Peri-1, 11 were Peri-2, and 15 were diffuse. The majority were male (nâ¯=â¯26), with a mean (standard deviation) age of 55.3 (11.3) years, who often presented with headache (nâ¯=â¯37) and nausea (nâ¯=â¯28). Overall, patients in Peri-1 were significantly less likely to have hydrocephalus compared to Peri-2 and dSAH (P= .003), and 4 patients required an external ventricular drain. Five patients developed symptomatic vasospasm. Patients in Peri-1, compared to Peri-2 and diffuse, had a significantly shorter median neuro critical care unit length of stay (LOS) and hospital LOS. Most patients (nâ¯=â¯35) had a discharge modified Rankin Score between 0 and 2 with no significant differences found between groups. CONCLUSION: These data suggest that patients with the best clinical course were those in Peri-1, followed by Peri-2, and then diffuse. Because these patients often present with similar clinical signs, stratifying by hemorrhage pattern may help clinicians predict which patients with perimesencephalic subarachnoid hemorrhage develop complications.
Asunto(s)
Hemorragia Subaracnoidea/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Anciano , Evaluación de la Discapacidad , Femenino , Estado de Salud , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Recuperación de la Función , Estudios Retrospectivos , Factores de Riesgo , Hemorragia Subaracnoidea/clasificación , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/terapia , Factores de TiempoRESUMEN
INTRODUCTION: Transcranial color-coded duplex sonography (TCCS) may help guide multimodal monitoring in the neurocritical setting. It may provide indirect information about intracranial hypertension, such as midline shift, third ventricle width, and peri-mesencephalic cistern obliteration. We aim to assess the agreement between brain computed tomography scan (CT scan) and TCCS in traumatic brain injury (TBI) patients. METHODS: In this retrospective cross-sectional observational study, TCCS was performed within 6 h before a brain CT scan. Only the first CT and TCCS after ICU admission were included. The agreement between the CT scan and TCCS was assessed by Bland-Altman plots and evaluating the intraclass correlation coefficient. RESULTS: Overall, 15 consecutive patients were included (80% male, 42 ± 23 years of age, Glasgow Coma Score 5 [4,6]). The mean difference between the brain CT scan and TCCS in measuring the midline shift was 0.30 ± 2.1 mm (intraclass correlation coefficient: 0.93; p < 0.01). An excellent correlation was also observed between the methods in assessing the third ventricle width (intraclass correlation coefficient: 0.88; p < 0.01). Bland-Altman plots did not show any systematic bias in either agreement analysis. TCCS showed good accuracy in predicting non-compressed peri-mesencephalic cisterns (AUC: 0.83, 95% CI 0.46-1.0) and the presence of the Sylvian fissure (AUC: 0.91, 95% CI 0.73-1.0) on CT scan. CONCLUSION: TCCS is a promising tool and may be an alternative to CT scans for evaluating TBI patients.