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(Stroke. 2002;33:2153.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Global Cerebral Edema After Subarachnoid Hemorrhage

A. Lagares, MD; P.A. Gómez, PhD; J.F. Alén, MD R.D. Lobato, PhD

Department of Neurosurgery

J. Campollo, MD

Department of Neuroradiology, Hospital 12 de Octubre, Madrid, Spain

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We have read with great interest the article by Claassen et al on cerebral edema after subarachnoid hemorrhage (SAH).¹ Their results are in agreement with those we presented in another recent article.² When analyzing the factors associated with bad prognosis at hospital admission in 294 patients suffering SAH admitted to our center during a 10-year interval, global cerebral hypodensity was present in 7% of the patients, a figure similar to that presented by the authors. Global brain hypodensity stood as an independent factor for bad prognosis in both univariate and multivariate logistic regression analyses. In our series, as in this recent article, global brain hypodensity in the admission CT was clearly related to mortality, as more than 90% of patients with this factor died, sooner than patients without edema (median 2 versus 10, 2 versus 8 in the Claassen et al series) and more often as a direct result of the hemorrhage (84% in our series).

The analysis of which factors are related to global brain edema is a unique feature of the study by Claassen et al. We have performed the same analysis in our own data, as presented in theTable. The level of consciousness at admission was the main variable related to the presence of global brain hypodensity in our series, and loss of consciousness at stroke was also an associated factor in the univariate analysis. We agree with the mechanisms the authors propose as responsible for the presence of global brain hypodensity. Ictal circulatory arrest . . . [Full Text of this Article]

Jan Claassen, MD Stephan A. Mayer, MD

Neurological Institute, Columbia University, New York, New York

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