Role of Computed Tomography Perfusion in Detection of Patients at Risk for Delayed Cerebral Ischemia After Subarachnoid Hemorrhage
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Subarachnoid Hemorrhage
- Sponsor
- Assiut University
- Enrollment
- 64
- Locations
- 1
- Primary Endpoint
- Mean transit time (MTT) on Admission
- Status
- Completed
- Last Updated
- 4 years ago
Overview
Brief Summary
Prospective evaluation of patients with subarachnoid hemorrhage (SAH) will be done by computed tomography angiography (CTA) and perfusion imaging (CTP) for any correlation between degree of vasospasm and perfusion deficit as well as evaluating the ability of CTP to predict delayed cerebral ischemia.
Detailed Description
Cerebral vasospasm is a serious complication of subarachnoid haemorrhage . In the first 2 weeks of SAH, angiographic vasospasm is seen up to 40-70% of patients and causes ischemic deficits in 15-36% of patients. The best clinical indicator of significantly reduced brain perfusion (cerebral blood flow (CBF)\<20 ml per 100 g/min) is the presence of new neurologic deficits. However, clinical symptoms may be vague and mimic other conditions in patients with SAH. CT Perfusion can be used in the evaluation of patients with possible vasospasm after subarachnoid hemorrhage (SAH). It can thus be used to assess cerebral ischemia and infarction as a result of vasospasm after SAH. The presence of cerebral vasospasm identified with transcranial Doppler, digital subtraction angiography, or CT angiography (CTA) is frequently used to confirm DCI. Presence of vasospasm, however, does not prove the presence of ischemia and absence of vasospasm does not rule out. Better diagnostic tests in the acute stage of deterioration, possibly caused by DCI, are therefore needed. In patients with SAH, CTP has recently been shown to be promising for detection of early ischemia.
Investigators
Mohamed Abdel-Tawab Mohamed
Assistant Lecturer
Assiut University
Eligibility Criteria
Inclusion Criteria
- •All patients presented with subarachnoid haemorrhage
Exclusion Criteria
- •Patients with abnormal renal functions with creatinine ≥ 2 mg/dl/
- •Patients with hypersensitivity to contrast media.
- •Contraindication to radiation as pregnancy.
Outcomes
Primary Outcomes
Mean transit time (MTT) on Admission
Time Frame: 3 days from the attack
Mean transit time (MTT) on Admission in units of seconds.
Cerebral blood flow (CBF) on Admission
Time Frame: 3 days from the attack
Cerebral blood flow (CBF) on Admission in units of ml/100 gram brain tissue/ minute. The measurements will be compared with the outcome of the patient (namely monitoring delayed cerebral ischemia in SAH patients) to test if early CT perfusion could predict the poor outcome in SAH patients.
Cerebral blood volume (CBV) on Admission
Time Frame: 3 days from the attack
Cerebral blood volume (CBF) on Admission in units of ml/100 gram brain tissue.
Secondary Outcomes
- Correlation of vasospasm to perfusion abnormality using Comparing between CT angiography and CT perfusion in patients with subarachnoid hemorrhage(4-14 days from the attack)
- Hunt and Hess scale(3 days from the attack)
- Fisher scale(3 days from the attack)