Skip to main content

Advertisement

SpringerLink
Log in

MRI Detection of Cerebral Infarction in Subarachnoid Hemorrhage

  • Original Article
  • Published:
Neurocritical Care Aims and scope Submit manuscript

Abstract

Objective

To investigate magnetic resonance imaging (MRI) detection of cerebral infarction (CI) in patients presenting with subarachnoid hemorrhage (SAH).

Background

CI is a well-known complication of SAH that is typically detected on computed tomography (CT). MRI has improved sensitivity for acute CI over CT, particularly with multiple, small, or asymptomatic lesions.

Methods

With IRB approval, 400 consecutive SAH patients admitted to our institution from August 2006 to March 2011 were retrospectively reviewed. Traumatic SAH and secondary SAH were excluded. Data were collected on demographics, cause of SAH, Hunt Hess and World Federation of Neurosurgical Societies grades, and neuroimaging results. MRIs were categorized by CI pattern as single cortical (SC), single deep (SD), multiple cortical (MC), multiple deep (MD), and multiple cortical and deep (MCD).

Results

Among 123 (30.8 %) SAH patients who underwent MRIs during their hospitalization, 64 (52 %) demonstrated acute CI. The mean time from hospital admission to MRI was 5.7 days (range 0–29 days). Among the 64 patients with MRI infarcts, MRI CI pattern was as follows: MC in 20 (31 %), MCD in 18 (28 %), SC in 16 (25 %), SD in 3 (5 %), MD in 2 (3 %), and 5 (8 %) did not have images available for review. Most infarcts detected on MRI (39/64 or 61 %) were not visible on CT.

Conclusions

The use of MRI increases the detection of CI in SAH. Unlike CT studies, MRI-detected CI in SAH tends to involve multiple vascular territories. Studies that rely on CT may underestimate the burden of CI after SAH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Rosengart AJ, Schultheiss KE, Tolentino J, Macdonald RL. Prognostic factors for outcome in patients with aneurysmal subarachnoid hemorrhage. Stroke. 2007;38:2315–21.

    Article  PubMed  Google Scholar 

  2. Vergouwen MDI, Ilodigwe D, Macdonald RL. Cerebral infarction after subarachnoid hemorrhage contributes to poor outcome by vasospasm-dependent and -independent effects. Stroke. 2011;42:924–9.

    Article  PubMed  Google Scholar 

  3. Fergusen S, Macdonald RL. Predictors of cerebral infarction in patients with aneursymal subarachnoid hemorrhage. Neurosurgery. 2007;60:658–67.

    Article  PubMed  Google Scholar 

  4. Rabinstein AA, Weigand S, Atkinson JLD, Wijdicks EF. Patterns of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2005;36:992–7.

    Article  PubMed  Google Scholar 

  5. Temes RE, Tessitore E, Schmidt JM, et al. Left ventricular dysfunction and cerebral infarction from vasospasm after subarachnoid hemorrhage. Neurocrit Care. 2010;13:359–65.

    Article  PubMed  Google Scholar 

  6. Kilbourn KJ, Levy S, Staff I, Kureshi I, McCullough L. Clinical characteristics and outcomes of neurogenic stress cardiomyopathy in aneurysmal subarachnoid hemorrhage. Clin Neurol Neurosurg. 2013;115:909–14.

    Article  PubMed  Google Scholar 

  7. Vergouwen MD, Vermeulen M, Coert BA, Stroes ES, Roos YB. Microthrombosis after aneurismal subarachnoid hemorrhage: an additional explanation for delayed cerebral ischemia. J Cereb Blood Flow Metab. 2008;28:1761–70.

    Article  PubMed  Google Scholar 

  8. Stein SC, Browne KD, Chen XH, Smith DH, Graham DI. Thromboembolism and delayed cerebral ischemia after subarachnoid hemorrhage: an autopsy study. Neurosurgery. 2006;59(4):781–7.

    Article  PubMed  Google Scholar 

  9. Dreier JP, Woitzik J, Fabricius M, et al. Delayed ischaemic neurological deficits after subarachnoid haemorrhage are associated with clusters of spreading depolarizations. Brain. 2006;129:3224–37.

    Article  PubMed  Google Scholar 

  10. Wagner M, Steinbes P, Güresir E, et al. Beyond delayed cerebral vasospasm: infarct patterns in patients with subarachnoid hemorrhage. Clin Neuroradiol. 2013;23:87–95.

    Article  CAS  PubMed  Google Scholar 

  11. Hijdra A, Van Gijn J, Stefanko S, Van Dongen KJ, Vermeulen M, Van Crevel H. Delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage: clinicoanatomic correlations. Neurology. 1986;36:329–33.

    Article  CAS  PubMed  Google Scholar 

  12. Vergouwen MD, Vermeulen M, van Gijn J, 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.

    Article  PubMed  Google Scholar 

  13. Crowley RW, Medel R, Dumont AS, et al. Angiographic vasospasm is strongly correlated with cerebral infarction after subarachnoid hemorrhage. Stroke. 2011;42:919–23.

    Article  PubMed  Google Scholar 

  14. Rabinstein AA, Friedman JA, Weigand SD, et al. Predictors of cerebral infarction in aneurysmal subarachnoid hemorrhage. Stroke. 2004;35(8):1862–6.

    Article  PubMed  Google Scholar 

  15. Naidech AM, Bendok BR, Bassin SL, Bernstein RA, Batjer HH, Bleck TP. Classification of cerebral infarction after subarachnoid hemorrhage impacts outcome. Neurosurgery. 2009;64(6):1052–7.

    Article  PubMed  Google Scholar 

  16. Frontera JA, Fernandez A, Schmidt JM, et al. Defining vasospasm after subarachnoid hemorrhage: what is the most clinically relevant definition? Stroke. 2009;40:1963–8.

    Article  PubMed  Google Scholar 

  17. Macdonald RL, Kassell NF, Mayer S, et al. Clazosentan to overcome neurological ischemia and infarction occurring after subarachnoid hemorrhage (CONSCIOUS-1): randomized, double-blind, placebo-controlled phase 2 dose-finding trial. Stroke. 2008;39:3015–21.

    Article  CAS  PubMed  Google Scholar 

  18. Forssell A, Larsson C, Ronnberg J, Fodstad H. CT assessment of subarachnoid haemorrhage: a comparison between different CT methods of grading subarachnoid haemorrhage. Br J Neurosurg. 1995;9:21–7.

    Article  CAS  PubMed  Google Scholar 

  19. De Rooij NK, Frijns CJ, Velthuis BK, Rinkel GJ. Secondary infarction in single or in multiple vascular territories: two different entities following subarachnoid hemorrhage? J Neurol. 2011;258:2133–9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Hadeishi H, Suzuki A, Yasui N, Hatazawa J, Shimosegawa E. Diffusion-weighted magnetic resonance imaging in patients with subarachnoid hemorrhage. Neurosurgery. 2002;50:741–8.

    Article  PubMed  Google Scholar 

  21. Wartenberg KE, Sheth SJ, Schmidt MJ, et al. Acute ischemic injury on diffusion-weighted magnetic resonance imaging after poor grade subarachnoid hemorrhage. Neurocrit Care. 2011;14(3):407–15.

    Article  PubMed  Google Scholar 

  22. Shimoda M, Takeuchi M, Tominaga J, Oda S, Kumasaka A, Tsugane R. Asymptomatic versus symptomatic infarcts from vasospasm in patients with subarachnoid hemorrhage: serial magnetic resonance imaging. Neurosurgery. 2001;49:1341–50.

    Article  CAS  PubMed  Google Scholar 

  23. Kramer AH, Mikolaenko I, Deis N, et al. Intraventricular hemorrhage volume predicts poor outcomes but not delayed ischemic neurological deficits among patients with ruptured cerebral aneurysms. Neurosurgery. 2010;67(4):1044–53.

    Article  PubMed  Google Scholar 

  24. Gross BA, Lin N, Rerichs KU, Du R. Vasospasm after spontaneous angiographically negative subarachnoid hemorrhage. Acta Neurochir. 2012;154:1127–33.

    Article  PubMed  Google Scholar 

  25. Kumar A, Brown R, Dhar R, et al. Early vs. delayed cerebral infarction after aneurysm repair after subarachnoid hemorrhage. Neurosurgery. 2013;74:617–23.

    Article  Google Scholar 

  26. Hoh BL, Topcuoglu MA, Singhal AB, et al. Effect of clipping, craniotomy, or intravascular coiling on cerebral vasospasm and patient outcome after aneurysmal subarachnoid hemorrhage. Neurosurgery. 2004;55:779–89.

    Article  PubMed  Google Scholar 

  27. Koivisto T, Vanninen R, Hurskainen H, Saari T, Hernesniemi J, Vapalahti M. Outcomes of early endovascular versus surgical treatment of ruptured cerebral aneurysms: a prospective randomized study. Stroke. 2000;31:2369–77.

    Article  CAS  PubMed  Google Scholar 

  28. Rabinstein AA, Pichelmann MA, Friedman JA, et al. Symptomatic vasospasm and outcomes following aneurysmal subarachnoid hemorrhage: a comparison between surgical repair and endovascular coil occlusion. J Neurosurg. 2003;98:319–25.

    Article  PubMed  Google Scholar 

  29. Cronqvist M, Wirestam R, Ramgren B, et al. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results MR findings and clinical outcome. Neuroradiology. 2005;47:855–73.

    Article  CAS  PubMed  Google Scholar 

  30. Soeda A, Sakai N, Sakai H, et al. Thromboembolic events associated with Guglielmi detachable coil embolization of asymptomatic cerebral aneurysms: evaluation of 66 consecutive cases with use of diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2003;24:127–32.

    PubMed  Google Scholar 

  31. Rordorf G, Bellon RJ, Budzik RE, et al. Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. AJNR Am J Neuroradiol. 2001;22:5–10.

    CAS  PubMed  Google Scholar 

  32. Vermeer SE, Longstreth WT Jr, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol. 2007;6:611–9.

    Article  PubMed  Google Scholar 

  33. Vergouwen MD, Etminan N, Ilodigwe D, Macdonald RL. Lower incidence of cerebral infarction correlates with improved functional outcome after aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2011;31:1545–53.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schmidt JM, Rincon F, Fernandez A, et al. Cerebral infarction associated with acute subarachnoid hemorrhage. Neurocrit Care. 2004;7:10–7.

    Article  Google Scholar 

  35. Shimoda M, Hoshikawa K, Shiramizu H, et al. Early infarction detection by diffusion-weighted imaging in patients with subarachnoid hemorrhage. Acta Neurochir. 2010;52:1197–205.

    Article  Google Scholar 

  36. Sato K, Shimizu H, Fujimura M, Inoue T, Matsumoto Y, Tominaga T. Acute-stage diffusion-weighted magnetic resonance imaging for predicting outcome of poor-grade aneurysmal subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2010;30:1110–20.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Frontera JA, Ahmed W, Zach V, et al. Acute ischaemia after subarachnoid hemorrhage, relationship with early brain injury and impact on outcome: a prospective quantitative MRI study. J Neurol Neurosurg Psychiatry. 2015;86(1):71–8.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, University of California Los Angeles, 757 Westwood Blvd Room 6236, Los Angeles, CA, 90095, USA

    Georgia Korbakis

  2. Department of Neurology, Northwestern University Feinberg School of Medicine, 303 E Chicago Ave, Chicago, IL, 60611, US

    Shyam Prabhakaran

  3. Section of Neurocritical Care, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street #1121, Chicago, IL, 60612, US

    Sayona John, Rajeev Garg & Thomas P. Bleck

  4. Section of Cerebrovascular Disease, Department of Neurological Sciences, Rush University Medical Center, 1725 West Harrison Street #1121, Chicago, IL, 60612, US

    James J. Conners & Vivien H. Lee

Authors
  1. Georgia Korbakis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shyam Prabhakaran
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sayona John
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rajeev Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. James J. Conners
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas P. Bleck
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vivien H. Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georgia Korbakis.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Korbakis, G., Prabhakaran, S., John, S. et al. MRI Detection of Cerebral Infarction in Subarachnoid Hemorrhage. Neurocrit Care 24, 428–435 (2016). https://doi.org/10.1007/s12028-015-0212-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12028-015-0212-z

Keywords

Search

Navigation