Transcranial Doppler for Early Prediction of Cognitive Impairment after Aneurysmal Subarachnoid Hemorrhage and the Associated Clinical Biomarkers
Bibliographic record
Abstract
Background and Aim. Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) stays under investigation. This study is aimed at predicting the cognitive impairment by transcranial Doppler (TCD) and detecting the associated clinical biomarkers of impaired cognition after aSAH after 3 months from the onset. Methods. Prospective study included 40 cases with acute aSAH. Initial evaluation by Glasgow Coma Scale (GCS) and the severity of aSAH was detected by both the clinical Hunt and Hess and radiological Fisher’s grading scales. TCD was done for all patients five times within 10 days measuring the mean flow velocities (MFVs) of cerebral arteries. At the 3-month follow-up, patients were classified into two groups according to Montreal Cognitive Assessment (MoCA) scale: the first group was 31 cases (77.5%) with intact cognitive functions and the other group was 9 cases (22.5%) with impaired cognition. Results. Patients with impaired cognitive functions showed significantly lower mean GCS ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M1"> <mi>p</mi> <mo>=</mo> <mn>0.03</mn> </math> ), significantly higher mean Hunt and Hess scale grades ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M2"> <mi>p</mi> <mo>=</mo> <mn>0.04</mn> </math> ), significantly higher mean diabetes mellitus (DM) ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M3"> <mi>p</mi> <mo>=</mo> <mn>0.03</mn> </math> ), significantly higher mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M4"> <mi>p</mi> <mo>=</mo> <mn>0.02</mn> </math> and <math xmlns="http://www.w3.org/1998/Math/MathML" id="M5"> <mi>p</mi> <mo>=</mo> <mn>0.005</mn> </math> , respectively), and significantly higher MFVs measured within the first 10 days. The patients with cognitive impairment were accompanied by a higher incidence of hydrocephalus ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M6"> <mi>p</mi> <mo>=</mo> <mn>0.01</mn> </math> ) and a higher incidence of delayed cerebral ischemia (DCI) ( <math xmlns="http://www.w3.org/1998/Math/MathML" id="M7"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ). Logistic regression analysis detected that <math xmlns="http://www.w3.org/1998/Math/MathML" id="M8"> <mtext>MFV</mtext> <mo>≥</mo> <mn>86</mn> <mo> </mo> <mo> </mo> <mtext>cm</mtext> <mo>/</mo> <mtext>s</mtext> </math> in the middle cerebral artery (MCA), <math xmlns="http://www.w3.org/1998/Math/MathML" id="M9"> <mtext>MFV</mtext> <mo>≥</mo> <mn>68</mn> <mo> </mo> <mo> </mo> <mtext>cm</mtext> <mo>/</mo> <mtext>s</mtext> </math> in the anterior cerebral artery (ACA), and <math xmlns="http://www.w3.org/1998/Math/MathML" id="M10"> <mtext>MFV</mtext> <mo>≥</mo> <mn>45</mn> <mo> </mo> <mo> </mo> <mtext>cm</mtext> <mo>/</mo> <mtext>s</mtext> </math> in the posterior cerebral artery (PCA) were significantly associated with increased risk of cognitive impairment. Conclusion. Cognitive impairment after the 3-month follow-up phase in aSAH patients was 22.5%. Acute hydrocephalus and DCI are highly associated with poor cognitive function in aSAH. Increased MFV is a strong predictor for poor cognitive function in aSAH. This trial is registered with NCT04329208.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".