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Currently no biological or radiological marker is available to identify patients at risk of Delayed Is-Chemic Deficit (DIND) after
Aneurysmal Sub-Arachnoid Hemorrhage (aSAH). We have described about our initial experience using MR-based semiquantitative
assessment of Cerebro-Vascular Reserve (CVR) to detect early radiological markers of vasospasm and DIND. Blood-
Oxygen Level Dependent-MRI (BOLD-MRI) images with CO2 challenge was obtained in 5 patients with aSAH for assessment of
whole brain CVR. Patients were examined as soon as possible after aneurysm treatment and good quality anatomical and functional
images were obtained without complications. Initial anatomical cerebrovascular imaging showed no vasospasm in all patients. Two
patients had abnormal CVR-MRI tests and both developed DIND. Of the 3 others with normal CVR-MRI, one developed posterior
circulation DIND. One patient with a normal CVR-MRI developed angiographic vasospasm but no DIND. Changes in CVR maps as
early as 36 hours after hemorrhage (day 1 of SAH) had good spatial correlation with delayed ischemia during short-term follow-up.
Our series shows that MRI with CO2 challenge is feasible in this population, known to be difficult to study in the acute phase. Further
developments might allow BOLD-MRI with CO2 challenge to identify patients at risk and provide anatomical correlation with future
DIND, opening a new venue for prophylactic treatments.