Dupont Stefan A, Wijdicks Eelco F M, Manno Edward M, Lanzino Giuseppe, Brown Robert D, Rabinstein Alejandro A
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Neurocrit Care. 2009;11(1):71-5. doi: 10.1007/s12028-009-9227-7. Epub 2009 May 16.
The initial noncontrast computed tomography (CT) study of the head after an aneurysmal subarachnoid hemorrhage (SAH) is used to predict the risk of developing vasospasm. Changes in the extent of subarachnoid blood seen on CT images occur as a function of time after SAH, but there is no consensus on the time interval during which this study needs to be completed.
Clinical and radiological information on adult SAH patients were reviewed. Patients were grouped based on the time elapsed from ictus to the initial head CT study. The amount of subarachnoid blood on CT was graded using the Hijdra sum score (HSS) and the modified Fisher scale (MFS). The relationship between the initial CT grading score and the risk of angiographic vasospasm was assessed for each group.
A total of 224 consecutive patients were identified (145 females, 65%). Initial CT was performed within 24 h of the event in 163 (Group 1, 73%) and after 24 h in 61 patients (Group 2, 27%). A total of 54 patients (24%) developed angiographic vasospasm. A statistically significant association between the extent of subarachnoid blood and subsequent development of vasospasm was observed only if the initial CT imaging study was performed within 24 h of aneurysmal rupture (P = 0.0001 and 0.02 for HSS and MFS, respectively).
We propose that only CT scans obtained within 24 h of a subarachnoid bleeding event should be used to estimate the risk of vasospasm.
动脉瘤性蛛网膜下腔出血（SAH）后最初的头部非增强计算机断层扫描（CT）研究用于预测发生血管痉挛的风险。CT图像上蛛网膜下腔出血范围的变化是SAH后时间的函数，但对于完成这项研究所需的时间间隔尚无共识。
回顾了成年SAH患者的临床和放射学信息。根据从发病到最初头部CT研究的时间对患者进行分组。使用Hijdra总和评分（HSS）和改良Fisher量表（MFS）对CT上的蛛网膜下腔出血量进行分级。评估每组初始CT分级评分与血管造影性血管痉挛风险之间的关系。
共确定了224例连续患者（145例女性，65%）。163例（第1组，73%）在事件发生后24小时内进行了初始CT检查，61例患者（第2组，27%）在24小时后进行了检查。共有54例患者（24%）发生了血管造影性血管痉挛。仅当在动脉瘤破裂后24小时内进行初始CT成像研究时，才观察到蛛网膜下腔出血程度与随后血管痉挛发生之间存在统计学显著关联（HSS和MFS分别为P = 0.0001和0.02）。
我们建议仅应使用蛛网膜下腔出血事件后24小时内获得的CT扫描来估计血管痉挛的风险。
