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Published in: Neurocritical Care 1/2020

01-08-2020 | Subarachnoid Hemorrhage | A Day in the Life of a Neurocritical Care Trainee

CT Perfusion for the Detection of Delayed Cerebral Ischemia in the Presence of Neurologic Confounders

Authors: Shaurya Taran, Daniel M. Mandell, Victoria A. McCredie

Published in: Neurocritical Care | Issue 1/2020

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Excerpt

Delayed cerebral ischemia (DCI) is a common complication of aneurysmal subarachnoid hemorrhage (SAH), affecting up to 30% of patients and manifesting as new neurologic deficits or a declining level of consciousness, or both [1]. Timely identification and management of DCI are crucial to improving outcomes in patients with SAH [2]. However, diagnosing DCI remains challenging. Multiple confounders may present as worsening of the neurologic examination, potentially delaying recognition of underlying DCI. Moreover, confounders may hinder efforts to monitor the clinical response to a chosen therapy. Here, we present the case of a patient with SAH in whom the use of CT perfusion (CTP) scans was used to diagnose and subsequently manage DCI in the setting of multiple confounders. …
Literature
1.
go back to reference Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care. 2016;20(1):277.CrossRef Francoeur CL, Mayer SA. Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care. 2016;20(1):277.CrossRef
2.
go back to reference Vergouwen MD, et al. Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2011;31(7):1545–53.CrossRef Vergouwen MD, et al. Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2011;31(7):1545–53.CrossRef
3.
go back to reference Ma H, et al. A multicentre, randomized, double-blinded, placebo-controlled Phase III study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND). Int J Stroke. 2012;7(1):74–80.CrossRef Ma H, et al. A multicentre, randomized, double-blinded, placebo-controlled Phase III study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND). Int J Stroke. 2012;7(1):74–80.CrossRef
4.
go back to reference Kidwell CS, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368(10):914–23.CrossRef Kidwell CS, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368(10):914–23.CrossRef
5.
go back to reference Lannes M, et al. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol. Neurocrit Care. 2012;16(3):354–62.CrossRef Lannes M, et al. Milrinone and homeostasis to treat cerebral vasospasm associated with subarachnoid hemorrhage: the Montreal Neurological Hospital protocol. Neurocrit Care. 2012;16(3):354–62.CrossRef
6.
go back to reference Rowland MJ, et al. Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm. Br J Anaesth. 2012;109(3):315–29.CrossRef Rowland MJ, et al. Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm. Br J Anaesth. 2012;109(3):315–29.CrossRef
7.
go back to reference Vergouwen MD, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391–5.CrossRef Vergouwen MD, et al. Definition of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke. 2010;41(10):2391–5.CrossRef
8.
go back to reference Budohoski KP, et al. The pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2014;85(12):1343–53.CrossRef Budohoski KP, et al. The pathophysiology and treatment of delayed cerebral ischaemia following subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2014;85(12):1343–53.CrossRef
9.
go back to reference Dreier JP, et al. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain. 2006;129(Pt 12):3224–37.CrossRef Dreier JP, et al. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain. 2006;129(Pt 12):3224–37.CrossRef
10.
go back to reference Millikan CH. Cerebral vasospasm and ruptured intracranial aneurysm. Arch Neurol. 1975;32(7):433–49.CrossRef Millikan CH. Cerebral vasospasm and ruptured intracranial aneurysm. Arch Neurol. 1975;32(7):433–49.CrossRef
11.
go back to reference Sanelli PC, et al. Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2011;32(11):2047–53.CrossRef Sanelli PC, et al. Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2011;32(11):2047–53.CrossRef
12.
go back to reference Dankbaar JW, et al. Diagnostic threshold values of cerebral perfusion measured with computed tomography for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Stroke. 2010;41(9):1927–32.CrossRef Dankbaar JW, et al. Diagnostic threshold values of cerebral perfusion measured with computed tomography for delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. Stroke. 2010;41(9):1927–32.CrossRef
13.
go back to reference Greenberg ED, et al. Role of CT perfusion imaging in the diagnosis and treatment of vasospasm. Imaging Med. 2011;3(3):287–97.CrossRef Greenberg ED, et al. Role of CT perfusion imaging in the diagnosis and treatment of vasospasm. Imaging Med. 2011;3(3):287–97.CrossRef
14.
go back to reference Washington CW, Zipfel GJ. Detection and monitoring of vasospasm and delayed cerebral ischemia: a review and assessment of the literature. Neurocrit Care. 2011;15(2):312–7.CrossRef Washington CW, Zipfel GJ. Detection and monitoring of vasospasm and delayed cerebral ischemia: a review and assessment of the literature. Neurocrit Care. 2011;15(2):312–7.CrossRef
15.
go back to reference Carrera E, et al. Transcranial Doppler for predicting delayed cerebral ischemia after subarachnoid hemorrhage. Neurosurgery. 2009;65(2):316–23 (Discussion 323–4).CrossRef Carrera E, et al. Transcranial Doppler for predicting delayed cerebral ischemia after subarachnoid hemorrhage. Neurosurgery. 2009;65(2):316–23 (Discussion 323–4).CrossRef
16.
go back to reference Konstas AA, et al. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol. 2009;30(5):885–92.CrossRef Konstas AA, et al. Theoretic basis and technical implementations of CT perfusion in acute ischemic stroke, part 2: technical implementations. AJNR Am J Neuroradiol. 2009;30(5):885–92.CrossRef
17.
go back to reference Mnyusiwalla A, Aviv RI, Symons SP. Radiation dose from multidetector row CT imaging for acute stroke. Neuroradiology. 2009;51(10):635–40.CrossRef Mnyusiwalla A, Aviv RI, Symons SP. Radiation dose from multidetector row CT imaging for acute stroke. Neuroradiology. 2009;51(10):635–40.CrossRef
Metadata
Title
CT Perfusion for the Detection of Delayed Cerebral Ischemia in the Presence of Neurologic Confounders
Authors
Shaurya Taran
Daniel M. Mandell
Victoria A. McCredie
Publication date
01-08-2020
Publisher
Springer US
Published in
Neurocritical Care / Issue 1/2020
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-020-01005-2

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