Classification of cerebral infarction after subarachnoid hemorrhage impacts outcome

OBJECTIVE: Cerebral infarction (CI) after subarachnoid hemorrhage (SAH) is well described, but there is no validated classification. METHODS: We prospectively enrolled 119 consecutive patients with SAH. We recorded admission World Federation of Neurological Societies grade and Columbia computed tomographic scores. Vasospasm was defined as transcranial Doppler of greater than 120 cm/second or typical clinical symptoms. CI was defined by computed tomographic or magnetic resonance imaging scan, and the date of discovery was recorded. CI was classified by a previously published method (single versus multiple, cortical versus deep versus combined). Outcomes were assessed at 14 days or discharge with the National Institutes of Health Stroke Scale and modified Rankin Scale (mRS), and at 28 days and 3 months with the mRS. RESULTS: Vasospasm was associated with a higher risk of CI (odds ratio, 2.6; 95% confidence interval, 1.3-5.6; P = 0.01). The median time to detection was 4.2 days (interquartile range, 1.6-7.6 days) after SAH onset. CI classification was associated with the National Institutes of Health Stroke Scale score at 14 days ( P = 0.002) and intensive care unit length of stay ( P = 0.001). CI location (cortical, deep, or combined) was associated with National Institutes of Health Stroke Scale and mRS score at 14 days, and mRS score at 28 days and 3 months ( P ≤ 0.02 for all). In a multiple logistic regression model, CI classification, World Federation of Neurological Societies grade, aneurysm diameter, and age were all associated with mRS score at 28 days and 3 months ( P ≤ 0.05). Combined cortical and deep CI was associated with less improvement and poor outcome. CONCLUSION: CI classification predicts outcomes after SAH. Future reports of CI after SAH should include this or similar descriptive information.