naa a22 4500 510799566 CHVBK 20180411083349.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9869-3 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9869-3 Infarct Volume Predicts Delayed Recovery in Patients with Subarachnoid Hemorrhage and Severe Neurological Deficits [Elektronische Daten] [Neil Rosenberg, Storm Liebling, Adam Kosteva, Matthew Maas, Shyam Prabhakaran, Andrew Naidech] Background: Recovery is common after subarachnoid hemorrhage (SAH), even in patients who are severely disabled at hospital discharge. Little is known about predictors of late recovery in such patients, even though such knowledge may influence treatment decisions. We hypothesized that cerebral infarction volume would be associated with 3months outcomes in patients who are severely disabled at 14days. Methods: We prospectively identified consecutive aneurysmal SAH patients, documented the development of cerebral infarction, and ascertained the modified Rankin Scale (mRS) at 14days and 3months. We included patients with mRS 4 or 5 and NIH Stroke Scale (NIHSS) at least 8 on hospital day 14 (i.e., severe neurologic impairment) and calculated infarct volume in a semi-automated fashion using CT imaging. We explored outcome determinants with ordinal regression. Results: At 14days, 66 patients were severely disabled, 65 (98.5%) of whom had mRS of 5; the median NIHSS was 21 [14-24]. At 3months, 20 (32.8%) of the 61 patients with known outcomes were independent. Larger infarction volumes were associated with death (20.4 vs. 0.85mL, P=0.02). In ordinal regression, increased infarct volume was associated with the worse mRS after correction for WFNS grade, age, and withdrawal of life support (OR 1.01 per mL of infarct, 95% CI 1.01-1.03, P=0.01). Conclusions: After SAH, even with severe neurological injury at 14days, good recovery is frequent and is associated with lower infarction volume. These data may help clinicians inform surrogate decision makers as they plan the future care of such severely disabled patients. Springer Science+Business Media New York, 2013 Subarachnoid hemorrhage nationallicence Prognosis nationallicence Cerebral infarction nationallicence Rosenberg Neil Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut Liebling Storm Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut Kosteva Adam Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut Maas Matthew Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut Prabhakaran Shyam Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut Naidech Andrew Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 293-298 1541-6933 19:3<293 2013 19 12028 https://doi.org/10.1007/s12028-013-9869-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9869-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Rosenberg Neil Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut NATIONALLICENCE 700 1- Liebling Storm Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut NATIONALLICENCE 700 1- Kosteva Adam Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut NATIONALLICENCE 700 1- Maas Matthew Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut NATIONALLICENCE 700 1- Prabhakaran Shyam Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut NATIONALLICENCE 700 1- Naidech Andrew Section on Neurocritical Care, Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, 11th Floor, 60611, Chicago, IL, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 293-298 1541-6933 19:3<293 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer