Routine utilization of the transient hyperaemic response test after aneurysmal subarachnoid haemorrhage.

In order to explore the applicability of daily cerebral autoregulation monitoring through routine utilization of the transient hyperaemic response (THR) test in patients after aneurysmal subarachnoid haemorrhage (SAH), we performed THR tests daily in 50 consecutive patients with verified SAH. Out of 1167 studies, the test results were acceptable during 954 procedures (81.5%). 310 negative (32.5%; range 0.75-1.099; mean 1.03) and 644 positive (67.5%; range 1.10-1.77; mean 1.19) test results were obtained. Multiple logistic regression analysis revealed that the registration of negative THR in a middle cerebral artery (MCA) during the period of critical care was related to the patients' poor clinical grade (p-0.02) and Fisher CT-grade (p-0.04) on admission, to the development of vasospasm (p-0.003) and to the detection of ipsilateral intracerebral haemorrhage and/or cerebral infarction (p-0.01). The frequent registration of negative THR tests (negative results in > 30% of all the tests in an MCA) was independently related to the detection of ipsilateral intracerebral haemorrhage and/or cerebral infarction (p-0.0001). THR tests provide information about intracranial alterations and can be safely performed as a routine monitoring tool after SAH.

Cerebral hemodynamic impairment after aneurysmal subarachnoid hemorrhage as evaluated using transcranial doppler ultrasonography: relationship to delayed cerebral ischemia and clinical outcome.

OBJECT: In this study the authors evaluated the relative role of cerebral hemodynamic impairment (HDI) in the pathogenesis of delayed cerebral ischemia and poor clinical outcome after aneurysmal subarachnoid hemorrhage (SAH). METHODS: Cerebral hemodynamics were assessed daily with transcranial Doppler (TCD) ultrasonography in 55 consecutive patients with verified SAH. Hemodynamic impairment was defined as blood flow velocity (BFV) values consistent with vasospasm in conjunction with impaired autoregulatory vasodilation as evaluated using the transient hyperemic response tests in the middle cerebral arteries. A total of 1344 TCD examinations were performed, in which the evaluation of HDI was feasible during 80.9% and HDI was registered during 12% of the examinations. It was found that HDI occurred in 60% of patients and was frequently recorded in conjunction with severe vasospasm (p < 0.05) and a rapid increase of BFV values (p < 0.05). Detection of HDI was closely associated with the development of delayed ischemic brain damage after SAH (p < 0.05). Furthermore, because delayed ischemia was never observed in cases in which vasospasm had not led to the development of HDI, its occurrence increased significantly the likelihood of subsequent cerebral ischemia among the patients with vasospasm (p < 0.05). Detection of HDI was independently related to unfavorable clinical outcome according to Glasgow Outcome Scale at 6 months after SAH (p < 0.05). CONCLUSIONS: The results showed that HDI is common after SAH and can be evaluated with TCD ultrasonography in routine clinical practice. Detection of HDI could be useful for identifying patients at high or low risk for delayed ischemic complications and unfavorable clinical outcome after SAH.

Personality as a predictor of coping efforts in patients with multiple sclerosis.

The aim of the study was to explore personality traits as predictors of coping with disease-related distress in patients with multiple sclerosis (MS). All patients with clinically definite MS in a city with a population of approximately 100000 were asked to complete the NEO Personality Inventory and a multidimensional coping inventory (COPE). There was an 83% response rate yielding 49 patients for the study population and 49 controls, matched for age, gender and educational level to the MS-patients, were used as comparison. Only Neuroticism correlated significantly with emotion-focused coping in both groups. Extraversion and Openness to Experience were linked to task-oriented coping strategies in normal controls but not in the MS-group. Agreeableness was associated with avoidance-oriented coping strategies only in the MS-group. Thus, the relation of certain personality characteristics to the choice of strategies for coping with the disease-related distress appear to differ from coping with stressful problems in everyday life. As dispositional characteristics may interfere with adaptive coping responses, analysis of personality traits and coping strategies could contribute while attempting to relieve the consequences of chronic disease on everyday life.