Thick clot in the inferior limiting sulcus on the CT image as an indicator of the sylvian subpial hematoma in patients with aneurysmal subarachnoid hemorrhage.

Thick clot in the inferior limiting sulcus on the CT image as an indicator of the sylvian subpial hematoma in patients with aneurysmal subarachnoid hemorrhage.

World Neurosurg. 2019 Feb 01;:

Authors: Matsukawa H, Miyazaki T, Kiko K, Kamiyama H, Ota N, Noda K, Takahashi O, Shonai T, Fujisawa T, Tokuda S, Tanikawa R

Abstract
OBJECTIVE: The sylvian subpial hematoma (SSH) was occasionally observed in the aneurysm subarachnoid hemorrhage (aSAH) when accompanying with the thick clot in the inferior limiting sulcus (ILS). We aimed to determine whether the thickness of the clot in the ILS (TCILS) was an indicator of SSH.
METHODS: Data of 150 consecutive aSAH patients was retrospectively analyzed. The relationship between TCILS on axial CT image and the intraoperatively confirmed SSH. In patients without the SSH, the average of the clot thickness of the clot in the bilateral ILS was used. Primary outcome was the SSH.
RESULTS: The median TCILS of the SSH group (n=18, 12%) was larger than that of the non-SSH group (n=132, 88%) (21 mm v.s. 2.1 mm; P < 0.001). The intraclass correlation coefficient for the clot thickness in the right and left ILS between two observers were 0.97 (P < 0.001) and 0.85 (P < 0.001). The TCILS threshold of ≧6.0 mm was associated with the SSH with a sensitivity of 89% and specificity of 99%. The unadjusted and adjusted OR of the SSH of clot thickness in the affected ILS ≧ 6 mm relative to clot thickness in the affected ILS < 6 mm were 263 (95% CI, 46-5063) and 137 (95% CI, 19-3029), respectively.
CONCLUSIONS: The clot thickness in the ILS on CT image was easily measured and could be a marker of the SSH. The SSH assessment could be useful in helping us predict the clinical course in patients with aSAH.

PMID: 30716497 [PubMed - as supplied by publisher]

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