Retinal Vessel Analysis (rGA) at the Patient Bed in the Context of Non-traumatic Subarachnoid Haemorrhage

Study Overview
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Brief Summary
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A subarachnoid hemorrhage occurs in about 10 out of 100,000 people each year. This bleeding leads to irritation and constriction of blood vessels in the brain (vasospasm) in two out of three people affected within four to 21 days and thus to reduced blood flow. This can lead to a stroke and serious damage. In order to be able to diagnose and treat a constriction of the blood vessels at an early stage, there are various examination methods which, however, have various disadvantages such as radiation exposure of the patient, low sensitivity or high effort. Therefore, the prediction and timely therapy of vascular constrictions is currently only successful in a few cases before the reduced blood flow has already led to irreversible damage. The aim of this study is to investigate whether the so-called retinal vascular analysis can be used in addition to previous standard examinations for the early detection of diseases of the cerebral blood circulation. This method has few side effects and has been successfully used for 50 years to examine the blood circulation in the eye.

Official Title
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Retinal Vessel Analysis (rGA) at the Patient Bed in the Context of Non-traumatic Subarachnoid Haemorrhage

Conditions
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Non-traumatic Subarachnoid Haemorrhage

Intervention / Treatment
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* Diagnostic Test: retinal vascular analysis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Female or male patient, age ≥ 18 years Inpatient stay in the clinic Written informed consent for participation in the study prior to beginning of treatment Written consent for further evaluation of the images and for the scientific publication of the study results Non-traumatic subarachnoid haemorrhage confirmed by computer tomography or magnetic resonance tomography or cerebrospinal fluid puncture (collection of nerve water from the lower part of the lumbar spine Exclusion Criteria: Female or male patient < 18 years Pregnancy, Lactation Lack of written consent to participate in the study and to further evaluate the image material collected Known allergy to MS eye drops (active substance: phenylephrine/tropicamide Narrow chamber angle, narrow angle glaucoma, Terson syndrome (if it makes retinal vascular imaging impossible Persons in a dependency or employment relationship with the investigator Persons who are accommodated in a facility by judicial or administrative order Receipt and intake of a study drug within the last 30 days Supine position in bed

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Retinal fundoscopy<br>Retinal vascular analysis by retinal fundoscopy over a 3 week period in stationary patients after aneurysmatic subarachnoid hemorrhage | Diagnostic Test: retinal vascular analysis<br>* Retinal fundoscopy over a 3 week period in stationary patients after aneurysmatic subarachnoid hemorrhage<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Clinical Progression of Delayed cortical ischemia | Delayed cortical ischemia as ischemia in cranial computer tomography or cranial magnetic resonance tomography that occurred later than 24 hours after admission to hospital | 21 days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of delayed ischemic neurological deficit (DIND) |  | 21 days | 
| Angiographic vasospasm | Occurence of an angiographic vasospasm measured by: Digital subtraction angiography at day 7 +/- 2 days or transcranial doppler sonography: flow increase >150 cm/s absolute or increase >50 cm/s within 24 h | 7 days | 
| Metabolic deficiency supply | Measured as change in lactate-pyruvate ratio in microdialysis | 21 days | 
| Metabolic deficiency supply | Measured as change in reduction in parenchymal oxygen partial pressure measurement | 21 days | 
| Relative underperfusion | Measured by Perfusion-Computer-Tomography | 21 days | 
| Objective degree of recovery | Measured by Glasgow-Outcome-Scale; Scale by which patients who have experienced brain damage can be divided into 5 groups that allow to describe the degree of recovery in a standardized and objective manner (1: death; 2: vegetative condition, the patient is unresponsive. The higher cognitive functions are extinguished; 3: severe disability, the patient is conscious, but cannot cope with normal everyday activities without help; 4: moderate disability, the patient can live largely independently, but is not able to pursue a normal working life; 5: light to no handicap, the neurological, physical, and psychological deficits are so low that the patient can participate normally in social and economic activities) | 3 Month |