Highlights
- •Elevated D-dimer levels were associated with poor outcomes.
- •Early brain injury (EBI) was frequently observed in the paramedian frontal lobe.
- •EBI had significantly higher incidence of poor-grade SAH and poor outcomes.
- •Patients with EBI had significantly higher D-dimer levels than those without EBI.
Abstract
Background
The pathological mechanisms of early brain injury (EBI) have remained obscure. Several
studies have reported on the neuroradiological findings of EBI. However, to our knowledge,
no study has attempted to explore the mechanism of EBI after subarachnoid hemorrhage
(SAH). Therefore, this study evaluates whether the initial plasma D-dimer levels were
associated with EBI, classifies magnetic resonance imaging (MRI) findings, and speculates
about the mechanism of EBI.
Methods
This study included 97 patients hospitalized within 24 h from the onset of nontraumatic
SAH. The patients underwent MRI within 0–5 days from onset (before vasospasm) to detect
EBI. EBI was radiologically defined as diffusion-weighted imaging (DWI)-positive lesions
that appear dark on apparent diffusion coefficient maps, excluding procedure-related
lesions. EBI, plasma D-dimer levels, and clinical features were retrospectively investigated.
Results
Elevated D-dimer levels were associated with poor outcomes. Patients with EBI had
significantly higher D-dimer levels than those without EBI. EBI was detected in 24
patients (27.3%) of all, and in 22 (45%) of 49 patients with World Federation of Neurosurgical
Societies (WFNS) grade 4–5 SAH. EBI was frequently observed in the paramedian frontal
lobe. There were several types of the pathology in EBI, including widespread symmetrical
cerebral cortex lesions, focal cortex lesions, periventricular injury, and other lesions
impossible to classify due to unknown mechanisms such as thrombotic complication and
microcirculatory disturbance, ultra-early spasm, and spreading depolarization.
Conclusions
This study suggests that D-dimer levels predict poor outcomes in patients with SAH
and that EBI was associated high D-dimer levels.
Key Words
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Article info
Publication history
Published online: October 21, 2021
Accepted:
August 16,
2021
Received in revised form:
August 14,
2021
Received:
May 27,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106073
Copyright
© 2021 Published by Elsevier Inc.
