ABSTRACT
Vasospasm has been known to cause permanent morbidity in 40-70% of survivors who suffered from subarachnoid hemorrhage (SAH). Early recognition of vasospasm is the key to better outcome of SAH. Cerebral angiography is expensive and impractical as a monitoring tool. Transcranial Doppler is operator dependent, and not readily available. The objective of this study is to devise a non invasive tool to screen for cerebral vasospasm following SAH. The proposed vasospasm score was based on clinical and cranial CT scan features. The features are hypertension, admission World Federation of Neurosurgeons Score (WFNS), amount of blood in the cisterns and subarachnoid space, intraventricular hemorrhage and hydrocephalus. Thirty six patients with aneurismal SAH were assessed retrospectively and correlated with the angiogram for vasospasm. The patients’ vasospasm score and their corresponding sensitivity and specificity were: 1 (100%, 0%), 2 (100%, 8%), 3 (100%, 8%), 4 (100%, 8%), 5 (91%, 46%), 6 (74%, 85%), 7 (48%, 85%), 8 (26%, 23%), 9 (3%, 100%), 10 (4%, 100%). A receiver operator characteristic curve was constructed that yielded a cut-off score of 6. The score of 6 was a good trade-off between sensitivity (74%) and specificity (85%). A clinical vasospasm score was proposed to screen for vasospasm after SAH. A score of 4 to 6 was found to correlate with angiographic vasospasm. Prospective study is required to validate the scoring system.
Subject(s)
Subarachnoid HemorrhageABSTRACT
In order to have the statistical basis of intracranial aneurysms, the authors analyzed the cases of angiographically proven intracranial aneurysms which were admitted to the department of neurosurgery, Seoul National University Hospital from Sep. 1957 to June 1988. The results of analysis were summarized as follows; 1) Total number of patients was 564 and 64 patients had multiple aneurysms, so total number of aneurysms was 647. Peak age incidence was in the 5th & 6th decades and male to female ratio was 1 : 1.2. 2) Location of aneurysms were anterior communicating artery(32%), posterior communicating artery(28.1%), middle cerebral artery(21.5%) in the order of frequency. Posterior circulation aneurysms comprised 7.1% and multiple aneurysms were 11.3%. 3) Among 647 aneurysms, 368 aneurysms were neck-clipped(56.9%), and operative mortality was 4.9%. 4) After 1983, 300 patients of 344 aneurysms were admitted to the neurosurgical department. The size of aneurysm was most frequent in 6-10 mm in diameter(49.4%) and 5 giant aneurysms were detected. 5) Among 344 aneurysms, 253 aneurysms were neck-clipped(73.5%) and operative mortality were lowered to 2.4%. 6) Among 300 patients 287 patients had ruptured aneurysm. Angiographic spasm was detected in 32.1% and symptomatic spasm was in 19.5%. 7) Hydrocephalus was detected in 36.2% during the period of admission and follow-up. 8) Anterior communicating artery aneurysms ruptured most frequently among the multiple aneurysms. 9) Clinical state on admission was an important factor for the outcome and preoperative clinical state was related to the operative outcome and mortality.