Post-trauma subarachnoid hemorrhage

Purpose

Assessment of the incidence of coronary complication during post-trauma subarachnoïd hemorrhage (SAH).

Methods

An open, double-blind, prospective study, during a period of 15 months in the Department of Anesthesia and Resuscitation of the National Institute of Neurology of Tunis.

Patients

Thirty-five patients with head trauma in whom a CT scan reveals a SAH on admission. Patients with cardiovascular history, thorax trauma, neurological coma related to a vascular pathology and non-neurological coma were excluded.

Results

The mean age of patients is 39 ± 17 years; 85% had a Glasgow Coma Scale < 8 on admission. The mean ISS was 27 ± 14, and 6% and 54% had a Fischer scale between 3 and 4, on admission. Electrocardiogram changes in 57% of patients. Troubles of repolarization are the most frequent; 94% of patients presented this trouble on the third day. The mean duration of these troubles is 4 ± 1 days. Over the three performed measurements, total CPK was increased in 88% of patients, creatine kinase MB isoenzyme was increased in 65% of patients and Troponin Ic was elevated in 34% of patients in a certain time of the evolution with an average of 0.068 (± 0.2). The peak of Troponin Ic occurred on the third day with an average of 0.113 (± 0.338). The increase of Troponin Ic is associated with a poor CT scan grade. The elevation of Troponin Ic is correlated with T-wave anomalies in comparison with those of the ST segment. But it is not correlated to creatine kinase MB elevation. The T-wave troubles, which are more frequent, therefore reflect better a myocardic lesion and Troponin Ic compared with creatine kinase MB is a better indicator of myocardic ischemia during SAH. In our department, no case of mortality was related to a cardiac cause. The incidence of Troponin Ic and T-wave troubles could be considered predictive factors of mortality.

Conclusion

According to this study, troubles of repolarization during post-trauma SAH are frequent in the acute phase of the first 3 days. They could reflect a myocardic lesion as it is indicated by the increase of Troponin Ic, which is associated with severe neurological injuries.