Early Cerebral Infarction Following ASAH: Frequency, Risk Factors, Patterns, And Prognostic Significance

Background and purpose: Early cerebral infarction (ECI) followinganeurysmal subarachnoid hemorrhage (aSAH) remains poorly understood.Our aim was to investigate the frequency, risk factors, and impact on outcomeof this special episode, as well as to validate the prognostic value of apublished grading system for cerebral infarction.Methods: We retrospectively enrolled243consecutive patients whounderwent aneurysm treatment (surgical clipping or endovascular coiling)within60hours after the ictus. Independent predictors of ECI were tested bymultivariate analysis. According to a published classification system, cerebralinfarction was divided into single cortical, single deep, multiple cortical,multiple deep, and multiple combined (cortical and deep) infarction.Outcomes were assessed3-month later using the Glasgow Outcome Scale (GOS).Results: Among the243patients, a total of65patients (26.7%) had ECI.Preexisting hypertension (P=0.03), Hunt-Hess grade on admission (P=0.013),intraventricular hemorrhage (P=0.006), acute hydrocephalus (P=0.001),admission plasma glucose level (P<0.001), and treatment modality (P=0.016)were significantly associated with the presence of ECI. Treatment modality(odds ratio [OR]=16.265;95%confidence interval [CI]4.053-65.275;P<0.001), admission plasma glucose level (OR=1.418;95%CI1.162-1.730;P=0.001), and acute hydrocephalus (OR=6.667;95%CI1.591-27.949;P=0.009) were independent risk factors for the occurrence of ECI after aSAH.The two most common subtypes of ECI were single cortical (29.2%) andmultiple combined infarction (23.1%). Patients with combined cortical anddeep infarction were more likely to have a worse outcome compared withthose without infarction (P<0.05). Furthermore, occurrence of ECI wassignificantly associated with subsequent delayed cerebral infarction (DCI) (P=0.002) and unfavorable outcome (P<0.001).Conclusions: The frequency of ECI complicating the acute stage of aSAHwas comparable with reported in previous studies. Treatment modality,admission plasma glucose level, and presence of acute hydrocephalus weresignificantly associated with occurrence of ECI after aSAH. The occurrenceof ECI appears to be a potential risk factor for developing DCI and pooroutcome. Moreover, the classification system for cerebral infarction seems toprovide more detailed prognostic information for patients with aSAH.