J Korean Neurosurg Soc.  2002 Apr;31(4):325-330.

Management Outcome of Poor Grade Patients with Aneurysmal Subarachnoid Hemorrhage

• Song YJ
• Huh JT
• Cho CM

Abstract

OBJECTIVE
The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery.
METHODS
We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases).
RESULTS
Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases).
CONCLUSION
An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.

Keyword

Poor grade patient; Management outcome; Early surgery; Delayed surgery; Subarachnoid hemorrhage

MeSH Terms

Aneurysm*
Hemorrhage
Humans
Mortality
Subarachnoid Hemorrhage*