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Changes in Cerebral Perfusion with Induced Hypertension in Aneurysmal Subarachnoid Hemorrhage: A Pilot and Feasibility Study

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Abstract

Background

The effects of induced hypertension (IH) on cerebral perfusion after subarachnoid hemorrhage (SAH) are unclear. The objectives of this investigation are to: (1) determine whether there are differences in cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) measured with computed tomography perfusion (CTP) before and after IH; (2) evaluate differences in the presence of infarction and clinical outcome between patients with and without IH.

Methods

We performed a retrospective cohort analysis of 25 aneurysmal SAH patients. IH was initiated as per the standard institutional protocol when patients showed clinical symptoms of delayed cerebral ischemia (DCI). Differences in CBF, CBV, and MTT between early (<72 h after aneurysm rupture) and late (7–10 days after aneurysm rupture) CTP were quantified in patients with (n = 13) and without IH (n = 12). Outcome measures included cerebral infarction and clinical outcome at 3 months.

Results

Early MTT was significantly greater in the IH group compared to the no-IH group. There was no difference in early or late CBV or CBF between the two groups. In patients that received IH, there was a significant decrease in MTT between the early (7.0 ± 1.2 s) and late scans (5.8 ± 1.6 s; p = 0.005). There was no difference in the incidence of infarction (5/13 vs. 2/11) or poor outcome (3/11 vs. 6/13) between the IH and no-IH groups, respectively (p > 0.05).

Conclusions

Elevated MTT is a significant factor for the development of DCI in patients eventually requiring IH therapy and is improved by IH treatment. Therapies to prevent DCI and improve clinical outcome may need to be initiated earlier, when cerebral perfusion abnormalities are first identified.

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Authors and Affiliations

  1. Department of Medical Imaging, University of Toronto, 30 Bond Street, Room 3-077CC, Toronto, ON, M5B 1W8, Canada

    Amanda Murphy

  2. St. Michael’s Hospital, Toronto, ON, Canada

    Airton Leonardo de Oliveira Manoel

  3. Department of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada

    R. Loch Macdonald

  4. Department of Critical Care, St. Michael’s Hospital, Toronto, ON, Canada

    Andrew Baker

  5. Robarts Research Institute, London, ON, Canada

    Ting-Yim Lee

  6. Department of Medical Imaging, St. Michael’s Hospital, Toronto, ON, Canada

    Tom Marotta, Walter Montanera & Aditya Bharatha

  7. Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Richard Aviv

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  1. Amanda Murphy
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  2. Airton Leonardo de Oliveira Manoel
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Corresponding author

Correspondence to Amanda Murphy.

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Murphy, A., de Oliveira Manoel, A.L., Macdonald, R.L. et al. Changes in Cerebral Perfusion with Induced Hypertension in Aneurysmal Subarachnoid Hemorrhage: A Pilot and Feasibility Study. Neurocrit Care 27, 3–10 (2017). https://doi.org/10.1007/s12028-017-0379-6

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  • DOI: https://doi.org/10.1007/s12028-017-0379-6

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