Incidence, predictors, and impact of cerebral edema during the early brain injury phase of aneurysmal subarachnoid hemorrhage: A retrospective cohort study.

BACKGROUND

Early brain injury (EBI) is a common and serious complication of aneurysmal subarachnoid hemorrhage (aSAH) that occurs within the first 72 h after the event. Burden of cerebral edema during EBI (early cerebral edema [ECE]) and its impact on patient outcomes remains to be completely explored. The primary objective of our study was to determine the incidence and identify the predictors of ECE after aSAH using the Subarachnoid Hemorrhage Early Brain Edema Score (SEBES).

METHODS

This retrospective study included adult patients with aSAH of any severity grade presenting within 72 h of ictus and undergoing definitive treatment in our hospital over a three-year period. Our primary outcome of ECE was evaluated on non-contrast brain computed tomography. Our secondary outcomes were burden of systemic inflammatory markers in patients with and without ECE. Our tertiary outcomes were the incidence of intracranial pressure (ICP)-targeted interventions.

RESULTS

ECE was noted in 57.75 % (287/497) of aSAH patients and was predicted by younger age, higher total leucocyte count (TLC), and higher Modified Fischer grade (MFG). Though there was no difference in the inflammatory markers, external ventricular drain (EVD) placements were more frequently required among patients with ECE when compared to those without (67 % versus 33 %, p < 0.05).

CONCLUSIONS

The burden of ECE is high after aSAH especially among the younger patients with higher MFG, and TLC, which may adversely affect outcomes. Our study demonstrates the crucial role of edema in strongly predicting the need for additional maneuvers to restore the ICP.