The Relationship Between the Amount of Radiological Bleeding and The Development of Vasospasm in Aneurysm Hemorrhage: A 100-Case Retrospective Study
Abstract
Objective: Intracranial aneurysms are pathological dilations of the intracranial arterial wall. The rupture of an aneurysm and the subsequent hemorrhage into the subarachnoid, intraventricular, or subdural spaces constitute a significant clinical condition associated with high morbidity and mortality. Aneurysmal subarachnoid hemorrhage (SAH) can lead to various severe complications, one of the most critical being ischemia due to cerebral vasospasm. In this study, we aim to analyze the relationship between the amount of hemorrhage and vasospasm.
Method: This study was conducted on patients admitted to the Neurosurgery Clinic of the Ministry of Health Ankara Training and Research Hospital with a diagnosis of spontaneous subarachnoid hemorrhage (SAH). The diagnosis of SAH was established based on computed tomography (CT) imaging and lumbar puncture (LP) findings. To diagnose aneurysms, all patients underwent four-vessel cerebral digital subtraction angiography (DSA). The CT images obtained at the time of admission were evaluated using the Fisher grading system. Additionally, angiographic vasospasm was assessed. For the statistical evaluation of the obtained results, the Z-test and chi-square (X²) test were used to analyze proportions.
Results: The mean age of the patients was calculated as 49 years. The age distribution of the cases was as follows: 36% were in the 40-49 age group, 27% in the 50-59 age group, and 15% in the 60-69 age group. In terms of gender distribution, female predominance was observed, with 64% of the 100 cases being female and 36% male. According to the Fisher grading system, the highest incidence of subarachnoid hemorrhage on brain CT was observed in grade 3. The percentage of patients classified as Fisher grade 3 was 36%, followed by 33% in grade 4, 23% in grade 2, and 8% in grade 1. Angiographic vasospasm was defined as a contrast-narrowing phenomenon in the main cerebral arteries, which could be either focal or, in some cases, diffuse. Clinical vasospasm was detected in 23% of cases, whereas angiographic vasospasm was identified in 59% of cases. The highest incidence of angiographic vasospasm was observed in Fisher grade 3, at a rate of 42.4%. This was followed by 32.2% in grade 4, 18.6% in grade 2, and 6.8% in grade 1. The high incidence in Fisher grade 3 was found to be statistically significant (p<0.05).
Conclusion: Our study highlights both the advantages and limitations of the Fisher grading system. A statistically significant relationship was found between Fisher grade 3 and cerebral vasospasm.
Keywords
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References
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- Fuentes AM, Stone McGuire L, Amin-Hanjani S. Sex Differences in Cerebral Aneurysms and Subarachnoid Haemorrhage. Stroke. 2022;53(2):624-633. doi:10.1161/STROKEAHA.121.037147
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- Turan N, Heider RA, Zaharieva D, Ahmad FU, Barrow DL, Pradilla G. Sex Differences in the Formation of Intracranial Aneurysms and Incidence and Outcome of Subarachnoid Haemorrhage: Review of Experimental and Human Studies. Transl Stroke Res. 2016;7(1):12-19. doi:10.1007/s12975-015-0434-6
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- Loch Macdonald R. Management of cerebral vasospasm. Neurosurg Rev. 2006;29(3):179-193. doi:10.1007/s10143-005-0013-5
- Varol E. The Role of Computed Tomographic Angiography in Predicting the Development of Vasospasm Following Ruptured Intracranial Aneurysm Microsurgery. Cureus. 2023;15(9):e45386. Published 2023 Sep 16. doi:10.7759/cureus.45386
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- Cogswell PM, Lants SK, Davis LT, Donahue MJ. Vessel wall and lumen characteristics with age in healthy participants using 3T intracranial vessel wall magnetic resonance imaging. J Magn Reson Imaging. 2019;50(5):1452-1460. doi:10.1002/jmri.26750
- Wang JM, Chen QX. Risk Factors for Intraprocedural Rerupture during Embolization of Ruptured Intracranial Aneurysms. J Korean Med Sci. 2020;35(48):e430. Published 2020 Dec 14. doi:10.3346/jkms.2020.35.e430
Abstract
References
- Xu Z, Rui Y, Hagan JP, Kim DK. Intracranial aneurysms: pathology, genetics, and molecular mechanisms. Neuromolecular Med. 2019;21(4):325–343. doi:10.1007/s12017-019-08537-7.
- Findlay JM, Nisar J, Darsaut T. Cerebral Vasospasm: A Review. Can J Neurol Sci. 2016;43(1):15-32. doi:10.1017/cjn.2015.288
- Fang YJ, Mei SH, Lu JN, Chen Y, Chai ZH, Dong X et al. New risk score of the early period after spontaneous subarachnoid haemorrhage: For the prediction of delayed cerebral ischemia. CNS Neurosci Ther. 2019;25(10):1173-1181. doi:10.1111/cns.13202
- Claassen J, Bernardini GL, Kreiter K, Bates J, Du YE, Copeland D, et al. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid haemorrhage: the Fisher scale revisited. Stroke. 2001;32(9):2012-2020. doi:10.1161/hs0901.095677
- Fuentes AM, Stone McGuire L, Amin-Hanjani S. Sex Differences in Cerebral Aneurysms and Subarachnoid Haemorrhage. Stroke. 2022;53(2):624-633. doi:10.1161/STROKEAHA.121.037147
- İlhan, Yılmaz, Metehan Eseoğlu, and Bülent Timur Demirgil. "Spontaneous subarachnoid haemorrhage due to aneurysm: A retrospective review of 328 cases." Firat Medical Journal 17.3 (2012): 156-160.
- Bozkuş, Hakan, Ali Çetin SARIOĞLU, Subarachnoid haemorrhage in the elderly. Tutkish Journal of Geriatrich, 1999;2(4):167-172.
- Turan N, Heider RA, Zaharieva D, Ahmad FU, Barrow DL, Pradilla G. Sex Differences in the Formation of Intracranial Aneurysms and Incidence and Outcome of Subarachnoid Haemorrhage: Review of Experimental and Human Studies. Transl Stroke Res. 2016;7(1):12-19. doi:10.1007/s12975-015-0434-6
- Cras TY, Bos D, Ikram MA, Vergouwen MDI, Dippel DWJ, Voortman T, et al. Determinants of the Presence and Size of Intracranial Aneurysms in the General Population: The Rotterdam Study. Stroke. 2020;51(7):2103-2110. doi:10.1161/STROKEAHA.120.029296
- Kistler JP, Crowell RM, Davis KR, Heros R, Ojemann RG, Zervas T, et al. The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualised by CT scan: a prospective study. Neurology. 1983;33(4):424-436. doi:10.1212/wnl.33.4.424
- Smith ML, Abrahams JM, Chandela S, Smith MJ, Hurst RW, Le Roux PD. Subarachnoid haemorrhage on computed tomography scanning and the development of cerebral vasospasm: the Fisher grade revisited. Surg Neurol. 2005;63(3):229-235. doi:10.1016/j.surneu.2004.06.017
- Kassell NF, Sasaki T, Colohan AR, Nazar G. Cerebral vasospasm following aneurysmal subarachnoid haemorrhage. Stroke. 1985;16(4):562-572. doi:10.1161/01.str.16.4.562
- Yanming H, Xiaoyan L, Celin G, Xiaolong Qi, Huihua L, Xin L, Shuanglin Q. Volume of Aneurysmal Subarachnoid Hematoma Measured Quantitatively by 3D Slicer to Predict Symptomatic Cerebral Vasospasm. Neurol India. 2023;71(3):487-493. doi:10.4103/0028-3886.378671
- Bauer AM, Rasmussen PA. Treatment of intracranial vasospasm following subarachnoid hemorrhage. Front Neurol. 2014;5:72. Published 2014 May 20. doi:10.3389/fneur.2014.00072
- Donaldson L, Edington A, Vlok R, Astono I, Iredale T, Flower O, et al. The incidence of cerebral arterial vasospasm following aneurysmal subarachnoid haemorrhage: a systematic review and meta-analysis. Neuroradiology. 2022;64(12):2381-2389. doi:10.1007/s00234-022-03004-w
- Loch Macdonald R. Management of cerebral vasospasm. Neurosurg Rev. 2006;29(3):179-193. doi:10.1007/s10143-005-0013-5
- Varol E. The Role of Computed Tomographic Angiography in Predicting the Development of Vasospasm Following Ruptured Intracranial Aneurysm Microsurgery. Cureus. 2023;15(9):e45386. Published 2023 Sep 16. doi:10.7759/cureus.45386
- Kelly PD, Yengo-Kahn AM, Tang AR, Jonayhan SV, Reynolds RA, Ye F, et al. Conditional Vasospasm-Free Survival Following Aneurysmal Subarachnoid Hemorrhage. Neurocrit Care. 2022;37(1):81-90. doi:10.1007/s12028-022-01444-z
- Street JS, Pandit AS, Toma AK. Predicting vasospasm risk using first presentation aneurysmal subarachnoid hemorrhage volume: A semi-automated CT image segmentation analysis using ITK-SNAP. PLoS One. 2023;18(6):e0286485. Published 2023 Jun 1. doi:10.1371/journal.pone.0286485
- Cogswell PM, Lants SK, Davis LT, Donahue MJ. Vessel wall and lumen characteristics with age in healthy participants using 3T intracranial vessel wall magnetic resonance imaging. J Magn Reson Imaging. 2019;50(5):1452-1460. doi:10.1002/jmri.26750
- Wang JM, Chen QX. Risk Factors for Intraprocedural Rerupture during Embolization of Ruptured Intracranial Aneurysms. J Korean Med Sci. 2020;35(48):e430. Published 2020 Dec 14. doi:10.3346/jkms.2020.35.e430
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences (Other) |
| Journal Section | Research articles |
| Authors | |
| Publication Date | May 31, 2025 |
| Submission Date | November 12, 2024 |
| Acceptance Date | March 27, 2025 |
| Published in Issue | Year 2025 Volume: 11 Issue: 2 |
e-ISSN 2149-7796