Prognostic factors of hunt and hess grade V subarachnoid hemorhage patients

Abstract

Objective: This study was designed to identify the prognostic factors of patients with Hunt and Hess grade (HHG) V aneurismal subarachnoid hemorrhage (SAH). Patients & Methods: Between March 1996 and June 2007, 81 patients presented with HHG V were selected. We reviewed the clinical record and images of them retrospectively. Median post-treatment follow up period was 17.0 months (range: 1 –119). Clinical outcome was assessed using modified Glasgow Outcome Scale. Possible prognostic factors were analyzed. Binary logistic regression analysis was performed.Results: Thirty two patients were male, and 49 patients were female. The median age was 55.5 years old (range: 27–81). Twenty three patients were Fisher group 3 and the remaining 58 patients were group 4. Twenty three patients suffered from repeated SAH before admission. The locations of aneurysms were anterior cerebral artery in 25, internal carotid artery in 21, middle cerebral artery in 25, and vertebrobasilar-posterior cerebral artery in 10 patients. Fifty nine patients had small, 21 had large, and 2 had giant aneurysms. The improvement of HHG was identified on 41 patients; from HGG V to IV in 37 patients, to HHG III in 2 patients, and to HHG II in 2 patients. Microsurgery was performed on 51 patients and endovascular treatment was performed on 30 patients. Early surgery was performed on 46 patients, intermediate surgery (between days 4 – 10) was performed on 24 patients, and delayed surgery was performed on 11 patients. The clinical outcome was good in 21, fair in 14, poor in 25, and dead in 21 patients. The statistically significant prognostic factors were the improvement of HGG before surgery and young age. The causes of unfavorable outcome might be brain damage by initial hemorrhage, treatment-related complications, and rebleeding of aneurysm. Conclusion: Although poor clinical grade on arrival, active management should be performed on younger patients and the patients with improved HHG