Brain Disorders and Therapeutics

Biography

Biography: Svetlana Lublinsky

Abstract

Disease progression and delayed neurological complications are common after aneurysmal subarachnoid hemorrhage (aSAH). We aimed at targeting the potential of quantitative blood-brain barrier (BBB) imaging to predict disease progression and neurological outcome. We retrospectively, blindly and semi-automatically, analyzed magnetic resonance images from 124 aSAH patients scanned at four time points (24-48 h, 6-8 days, 12-15 days and 6-12 months) after the initial hemorrhage. Volume of brain with apparent pathology and BBB-dysfunction, subarachnoid space and lateral ventricles were measured. Neurological status on admission was scored using the Rosen-Macdonald scores (RMS). Clinical outcome at >six months was assessed using the extended Glasgow outcome scale. Based on repeated volumetric measures of pathological brain tissue and CSF, patients were grouped into progressive and non-progressive disease course. No differences were found between the groups in aneurysm locations, neurological status on admission or initial brain pathology. Females were older and more likely to have a non-progressive course compared to males. Progressive course was associated with worse outcome at >six months. A significant brain volume with BBB-dysfunction was found already 24-48 hours after admission, and persisted at all-time points. Brain volume with BBB-dysfunction was significantly larger in patients with progressive compared with non-progressive course. BBB-dysfunction increased the likelihood of a normal brain tissue to turn into a pathological one. A multi-linear regression model revealed a significant power for BBB-dysfunction in combination with RMS at 24-48 hours to predict patient outcome. We suggest that early identification of BBB-dysfunction may serve as a key predictive biomarker for neurological outcome in aSAH.