Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage

Todd M. Lasner, Robert J. Weil, Howard A. Riina, Joseph T. King, Eric L. Zager, Eric C. Raps, Eugene S. Flamm

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is correlated with the thickness of blood within the basal cisterns on the initial computerized tomography (CT) scan. To identify additional risk factors for symptomatic vasospasm, the authors performed a prospective analysis of 75 consecutively admitted patients who were treated for aneurysmal SAH. Five patients who died before treatment or were comatose postoperatively were excluded from the study. Of the remaining 70 patients, demographic (age, gender, and race) and clinical (hypertension, diabetes, coronary artery disease, smoking, alcohol abuse, illicit drag use, sentinel headache. Fisher grade, Hunt and Hess grade, World Federation of Neurological Surgeons grade, and ruptured aneurysm location) parameter were evaluated using multivariate logistic regression to determine factors independently associated with cerebral vasospasm. All patients were treated with hypervolemic therapy and administration of nimodipine as prophylaxis for vasospasm. Cerebral vasospasm was suspected in cases that exhibited (by elevation of transcranial Doppler velocities) neurological deterioration 3 to 14 days after SAH with no other explanation and was confirmed either by clinical improvement in response to induced hypertension or by cerebral angiography. The mean age of the patients was 50 years. Sixty-three percent of the patients were women, 74% were white, 64% were cigarette smokers, and 46% were hypertensive. Ten percent of the patients suffered from alcohol abuse, 19% from sentinel bleed, and 49% had a Fisher Grade 3 SAH. Twenty- nine percent of the patients developed symptomatic vasospasm. Multivariate analysis demonstrated that cigarette smoking (p = 0.033: odds ratio 4.7,95% confidence interval [CI] 2.4-8.9) and Fisher Grade 3, that is, thick subarachnoid clot (p = 0.008: odds ratio 5.1.95% CI2-13.1), were independent predictors of symptomatic vasospasm. The authors make the novel observation that cigarette smoking increases the risk of symptomatic vasospasm after aneurysmal SAH, independent of Fisher grade.

Original languageEnglish (US)
Pages (from-to)381-384
Number of pages4
JournalJournal of Neurosurgery
Volume87
Issue number3
StatePublished - Sep 1997
Externally publishedYes

Fingerprint

Subarachnoid Hemorrhage
Smoking
Intracranial Vasospasm
Alcoholism
Odds Ratio
Hypertension
Nimodipine
Cerebral Angiography
Ruptured Aneurysm
Coma
Tobacco Products
Headache
Coronary Artery Disease
Multivariate Analysis
Logistic Models
Tomography
Observation
Demography
Confidence Intervals
Therapeutics

Keywords

  • Aneurysm subarachnoid hemorrhage
  • Cerebral vasospasm cigarette smoking

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Lasner, T. M., Weil, R. J., Riina, H. A., King, J. T., Zager, E. L., Raps, E. C., & Flamm, E. S. (1997). Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery, 87(3), 381-384.

Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. / Lasner, Todd M.; Weil, Robert J.; Riina, Howard A.; King, Joseph T.; Zager, Eric L.; Raps, Eric C.; Flamm, Eugene S.

In: Journal of Neurosurgery, Vol. 87, No. 3, 09.1997, p. 381-384.

Research output: Contribution to journalArticle

Lasner, TM, Weil, RJ, Riina, HA, King, JT, Zager, EL, Raps, EC & Flamm, ES 1997, 'Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage', Journal of Neurosurgery, vol. 87, no. 3, pp. 381-384.
Lasner TM, Weil RJ, Riina HA, King JT, Zager EL, Raps EC et al. Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery. 1997 Sep;87(3):381-384.
Lasner, Todd M. ; Weil, Robert J. ; Riina, Howard A. ; King, Joseph T. ; Zager, Eric L. ; Raps, Eric C. ; Flamm, Eugene S. / Cigarette smoking-induced increase in the risk of symptomatic vasospasm after aneurysmal subarachnoid hemorrhage. In: Journal of Neurosurgery. 1997 ; Vol. 87, No. 3. pp. 381-384.
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