Global cerebral atrophy after subarachnoid hemorrhage: a possible marker of acute brain injury and assessment of its impact on outcome

Acta Neurochir Suppl. 2013:115:17-21. doi: 10.1007/978-3-7091-1192-5_5.


There is a correlation between poor neuropsychological outcome and focal regions of atrophy in patients with subarachnoid hemorrhage (SAH). No study has investigated the impact of global brain atrophy on outcome after SAH. In other neurological disorders, such as multiple sclerosis, a correlation has been found between global atrophy and outcome. This analysis of patients entered into a randomized clinical trial of clazosentan in patients with SAH (CONSCIOUS-1) investigated the relationship between global cerebral atrophy, clinical factors, and outcome.The 413 patients in the CONSCIOUS-1 study underwent cranial computed tomography (CT) on admission and 6 weeks after SAH. After patients with large clip/coil artefacts and those with infarctions on CT were excluded, 97 patients remained and had voxel-based volumetric measurements of the baseline and 6-week CT scans. The percentage difference in volume between times was taken and analysed against clinical variables. Relationships were modeled using univariate and multivariate analysis.Age, female gender, and higher body temperature during the patient's stay in the intensive care unit were significantly correlated with brain atrophy. Greater brain atrophy significantly correlated with poor outcome (modified Rankin scale), more severe neurological deficits on the National Institute of Health Stroke Scale (NIHSS), and poorer health status (EQ-5D).

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Analysis of Variance
  • Atrophy / drug therapy
  • Atrophy / etiology
  • Atrophy / pathology
  • Body Weight / drug effects
  • Body Weight / physiology
  • Brain Injuries / diagnosis*
  • Brain Injuries / drug therapy
  • Brain Injuries / etiology
  • Cerebral Cortex / pathology*
  • Dioxanes / therapeutic use
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Pyridines / therapeutic use
  • Pyrimidines / therapeutic use
  • Statistics, Nonparametric
  • Subarachnoid Hemorrhage / complications
  • Subarachnoid Hemorrhage / drug therapy
  • Subarachnoid Hemorrhage / pathology*
  • Sulfonamides / therapeutic use
  • Tetrazoles / therapeutic use
  • Time Factors
  • Tomography, X-Ray Computed
  • Trauma Severity Indices
  • Treatment Outcome


  • Dioxanes
  • Pyridines
  • Pyrimidines
  • Sulfonamides
  • Tetrazoles
  • clazosentan