Beyond the initial impact of aneurysmal subarachnoid hemorrhage
Beyond the initial impact of aneurysmal subarachnoid hemorrhage
A ruptured brain aneurysm can cause a brain bleed called an aneurysmal subarachnoid hemorrhage (aSAH). This is a severe stroke that begins suddenly, often with a sudden, severe headache, and may also cause loss of consciousness or paralysis. About one in three patients die, and survivors often face major effects on daily life.
Even after treatment to prevent another bleed, serious complications can develop in the following days to weeks. One of these is reduced blood flow to parts of the brain, leading to insufficient oxygen in brain tissue. This is known as delayed cerebral ischemia (DCI). This can be caused by spasms in the large brain arteries and problems in the smaller blood vessels. As a result, strokes can occur, often leading to lasting disability. Early detection is therefore crucial.
This thesis of Joep van der Harst examined which methods may help predict DCI at an early stage. It looked at existing techniques such as ultrasound (TCD) and advanced imaging of the brain’s blood vessels (CTA). It also investigated a newer method, near-infrared spectroscopy (NIRS), which can measure oxygen levels in the brain. Finally, new scoring methods were developed to describe the severity and extent of DCI in a systematic and consistent way. The results of this thesis show that these scores may improve the prediction of DCI and are therefore promising for monitoring patients after a ruptured brain aneurysm. By combining these data, care can be tailored to the individual patient, with the aim of preventing brain injury at an early stage.