Contributing Factors for Favorable Outcome in Spite of Initially Poor Graded Aneurysmal Subarachnoid Hemorrhage Patients(Hunt-Hess grade IV, V)

Lee, Bong Hoon; Choi, Byung Yon; Kim, Sung Ho; Bae, Jang Ho; Kim, Oh Lyong; Cho, Soo Ho

Abstract

Aneurysmal subarachnoid hemorrhage carries a high rate of morbidity and mortality despite recent advance in the care of such patients. This is especially true in patients in poorer neurological condition(Hunt-Hess grade IV, V) after initial hemorrhage. Many factors are known to contribute to this poor outcome, but other factors might be contribute to the favorable outcome. This study underwent to examine in a prospective fashion to evaluate the influence of different clinical, radiological, and intra-operative factors upon eventual outcome to aid in determining the rationale for an aggressive management on individual cases. Total of 494 cases of SAH were surgically treated from Jan. 1984 to Sep. 1996. Among them, 92 cases(18.6%) were classified as Hunt-Hess grade IV, V. Favorable outcome was noted in 59 cases(64.1%), and poor outcome in 33 cases(35.9%). Statistically significant contributing factors for favorable outcome aare systolicBP<160mmHg, diastolic BP<90mmHg, stational status on attack, normal ranged serum sodium level, hemoglobin<15mg/dL, hematocrit<45%, SAH<3mm on CT scanning, no ICH, single aneurysm, no rebleeding, improved mentality, delayed operation(>24hr), and short operation time(<6hr).