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Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers

METHODS: Prospective study included 40 cases with acute aSAH. Initial evaluation by Glasgow Coma Scale (GCS) and the severity of aSAH was detected by both the clinical Hunt and Hess and radiological Fisher's grading scales. TCD was done for all patients five times within 10 days measuring the m...

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Autores principales: Esmael, Ahmed, Belal, Tamer, Eltoukhy, Khaled
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704183/
https://www.ncbi.nlm.nih.gov/pubmed/33299539
http://dx.doi.org/10.1155/2020/8874605
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author Esmael, Ahmed
Belal, Tamer
Eltoukhy, Khaled
author_facet Esmael, Ahmed
Belal, Tamer
Eltoukhy, Khaled
author_sort Esmael, Ahmed
collection PubMed
description METHODS: Prospective study included 40 cases with acute aSAH. Initial evaluation by Glasgow Coma Scale (GCS) and the severity of aSAH was detected by both the clinical Hunt and Hess and radiological Fisher's grading scales. TCD was done for all patients five times within 10 days measuring the mean flow velocities (MFVs) of cerebral arteries. At the 3-month follow-up, patients were classified into two groups according to Montreal Cognitive Assessment (MoCA) scale: the first group was 31 cases (77.5%) with intact cognitive functions and the other group was 9 cases (22.5%) with impaired cognition. RESULTS: Patients with impaired cognitive functions showed significantly lower mean GCS (p = 0.03), significantly higher mean Hunt and Hess scale grades (p = 0.04), significantly higher mean diabetes mellitus (DM) (p = 0.03), significantly higher mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p = 0.02 and p = 0.005, respectively), and significantly higher MFVs measured within the first 10 days. The patients with cognitive impairment were accompanied by a higher incidence of hydrocephalus (p = 0.01) and a higher incidence of delayed cerebral ischemia (DCI) (p < 0.001). Logistic regression analysis detected that MFV ≥ 86  cm/s in the middle cerebral artery (MCA), MFV ≥ 68  cm/s in the anterior cerebral artery (ACA), and MFV ≥ 45  cm/s in the posterior cerebral artery (PCA) were significantly associated with increased risk of cognitive impairment. CONCLUSION: Cognitive impairment after the 3-month follow-up phase in aSAH patients was 22.5%. Acute hydrocephalus and DCI are highly associated with poor cognitive function in aSAH. Increased MFV is a strong predictor for poor cognitive function in aSAH. This trial is registered with NCT04329208.
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spelling pubmed-77041832020-12-08 Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers Esmael, Ahmed Belal, Tamer Eltoukhy, Khaled Stroke Res Treat Research Article METHODS: Prospective study included 40 cases with acute aSAH. Initial evaluation by Glasgow Coma Scale (GCS) and the severity of aSAH was detected by both the clinical Hunt and Hess and radiological Fisher's grading scales. TCD was done for all patients five times within 10 days measuring the mean flow velocities (MFVs) of cerebral arteries. At the 3-month follow-up, patients were classified into two groups according to Montreal Cognitive Assessment (MoCA) scale: the first group was 31 cases (77.5%) with intact cognitive functions and the other group was 9 cases (22.5%) with impaired cognition. RESULTS: Patients with impaired cognitive functions showed significantly lower mean GCS (p = 0.03), significantly higher mean Hunt and Hess scale grades (p = 0.04), significantly higher mean diabetes mellitus (DM) (p = 0.03), significantly higher mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) (p = 0.02 and p = 0.005, respectively), and significantly higher MFVs measured within the first 10 days. The patients with cognitive impairment were accompanied by a higher incidence of hydrocephalus (p = 0.01) and a higher incidence of delayed cerebral ischemia (DCI) (p < 0.001). Logistic regression analysis detected that MFV ≥ 86  cm/s in the middle cerebral artery (MCA), MFV ≥ 68  cm/s in the anterior cerebral artery (ACA), and MFV ≥ 45  cm/s in the posterior cerebral artery (PCA) were significantly associated with increased risk of cognitive impairment. CONCLUSION: Cognitive impairment after the 3-month follow-up phase in aSAH patients was 22.5%. Acute hydrocephalus and DCI are highly associated with poor cognitive function in aSAH. Increased MFV is a strong predictor for poor cognitive function in aSAH. This trial is registered with NCT04329208. Hindawi 2020-11-23 /pmc/articles/PMC7704183/ /pubmed/33299539 http://dx.doi.org/10.1155/2020/8874605 Text en Copyright © 2020 Ahmed Esmael et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Esmael, Ahmed
Belal, Tamer
Eltoukhy, Khaled
Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers
title Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers
title_full Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers
title_fullStr Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers
title_full_unstemmed Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers
title_short Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers
title_sort transcranial doppler for early prediction of cognitive impairment after aneurysmal subarachnoid hemorrhage and the associated clinical biomarkers
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704183/
https://www.ncbi.nlm.nih.gov/pubmed/33299539
http://dx.doi.org/10.1155/2020/8874605
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