gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Characterization of dynamic autoregulation in patients following SAH

Meeting Abstract

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  • J. Fontana - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Rupprecht-Karls-Universität Heidelberg, Mannheim
  • J. Moratin - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Rupprecht-Karls-Universität Heidelberg, Mannheim
  • M. Arp - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Rupprecht-Karls-Universität Heidelberg, Mannheim
  • G. Ehrlich - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Rupprecht-Karls-Universität Heidelberg, Mannheim
  • K. Schmieder - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Rupprecht-Karls-Universität Heidelberg, Mannheim
  • M. Barth - Neurochirurgische Klinik, Universitätsmedizin Mannheim, Rupprecht-Karls-Universität Heidelberg, Mannheim

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocFR.09.03

doi: 10.3205/12dgnc237, urn:nbn:de:0183-12dgnc2371

Published: June 4, 2012

© 2012 Fontana et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: The purpose of the study was to evaluate the extent and time course of impaired dynamic cerebral autoregulation in patients following subarachnoidal hemorrhage (aSAH).

Methods: 51 patients following aSAH were prospectively included in the study. Digital subtraction angiography (DSA) was performed initially and at day 8 ± 1 with determination of the degree of proximal and global vasospasm. Following aneurysm occlusion dynamic autoregulation was examined daily until day 11 post bleeding using Aaslid's thigh cuff test resulting in autoregulation-index (ARI) values. Clinical scores such as the modified Rankin score (MRS), the extended Glasgow outcome scale (GOSE), and the national institute of health stroke scale (NIHSS) were documented daily.

Results: There is a significant correlation between median ARI values and clinical scores at discharge (MRS, p = 0.0021; GOSE, p = 0.0027; NIHSS p = 0.0091). There was a positive correlation between hemispheric median ARI values and the degree of proximal and global vasospasm in the MCA (both p values < 0.05). Using the Cochran-Armitage Trend Test, a significant difference between ARI values was observed in patients with favourable outcome (MRS 0–3) and unfavourable outcome (MRS of 4–6) on days 2, 3, 5, 7 and 8. Regression analysis showed a significant increase of ARI values over time (+ 0.1586 / day, p < 0.01) in patients with favourable outcome and a strong trend to decrease in patients with unfavourable outcome (–0.2282 / day, p = 0.06).

Conclusions: Based on the present data, impaired dynamic cerebral autoregulation seems to correlate with the degree of angiographic vasospasm and outcome in patients following aSAH. An early decrease of ARI values seems to be indicative for the development of angiographic vasospasm and unfavourable clinical outcome in patients following aSAH.