Aggarwal Varun, Sharma Achal, Sinha V D
Department of Neurosurgery, SMS Hospital, Jaipur, Rajasthan, India.
Asian J Neurosurg. 2018 Oct-Dec;13(4):1074-1077. doi: 10.4103/ajns.AJNS_73_17.
Aneurysmal SAH is the significant cause of morbidity and mortality in stroke patients. Early brain injury and delayed cerebral ischemia are the two main responsible pathophysiologic processes. Cerebral ischemia needs to be detected early so that early aggressive therapy could be started. Although Diffusion weighted imaging (DWI) has often been utilized for the measurement of acute ischemic strokes, its role in the detection of early cerebral ischemia due to aneurysmal subarachnoid hemorrhage has not been extensively investigated. This study is being carried out to describe the role of DWI in detecting early ischemic brain injury and outcome after aneurysmal SAH.
Efficacy of DWI in detecting ischemic injury and predicting outcome after aneurysmal SAH.
In this prospective study 44 consecutive patients who had aneurysmal SAH; admitted within 7 days of their ictus were included. Hunt and Hess grade on admission and modified Fisher grade of SAH were noted. Plain CT brain and MR DWI was done on day before surgery. Diffusion restriction on DWI was correlated with postoperative neurological deficit, postoperative CT finding and outcome of the patient at 1 month follow-up.
DWI revealed restricted diffusion in 12 patients, out of which 1 patient was having infarction in preoperative CT scan, 6 patients were having postoperative deficit in the form of disorientation, hemiparesis and aphasia, and all patients were having infarction in postoperative CT scan. When DWI findings were compared on the basis of postoperative neurological deficit, postoperative CT finding and modified Rankin outcome score at 1month follow-up, results were statistically significant.
DWI shows cerebral ischemia much earlier than CT scan in cases of aneurysmal SAH. It has significant correlation with postoperative neurological status and outcome of the patient.
动脉瘤性蛛网膜下腔出血（SAH）是卒中患者发病和死亡的重要原因。早期脑损伤和迟发性脑缺血是两个主要的病理生理过程。需要早期检测脑缺血，以便开始早期积极治疗。尽管扩散加权成像（DWI）常被用于测量急性缺血性卒中，但其在检测动脉瘤性蛛网膜下腔出血所致早期脑缺血中的作用尚未得到广泛研究。本研究旨在描述DWI在检测动脉瘤性SAH后早期缺血性脑损伤及预后中的作用。
DWI在检测动脉瘤性SAH后缺血性损伤及预测预后中的有效性。
在这项前瞻性研究中，纳入了44例连续的动脉瘤性SAH患者；发病7天内入院。记录入院时的Hunt和Hess分级以及SAH的改良Fisher分级。术前一天进行头颅平扫CT和磁共振DWI检查。DWI上的扩散受限与术后神经功能缺损、术后CT表现及患者1个月随访时的预后相关。
DWI显示12例患者存在扩散受限，其中1例患者术前CT扫描有梗死，6例患者术后出现定向障碍、偏瘫和失语等神经功能缺损，所有患者术后CT扫描均有梗死。根据术后神经功能缺损、术后CT表现及1个月随访时的改良Rankin预后评分对DWI结果进行比较，结果具有统计学意义。
在动脉瘤性SAH病例中，DWI比CT扫描更早显示脑缺血。它与患者术后神经状态和预后有显著相关性。
