Analysis of Prognosis in Poor-grade Aneurysmal Subarachnoid Hemorrhage

ABSTRACT

OBJECTIVE: Although early surgery is a generally accepted in good grade subarachnoid hemorrhage(SAH), patients in a poor grade have been excluded from aggressive treatment due to severely damaged brain after attack. This study describes the prognosis and cause of poor outcome in poor-grade SAH patients excluding the effect of hydrocephlalus. METHODS: We analyzed 217 patients of Hunt & Hess(H&H) grade IV and V from 1997 to 2001. The prognosis according to the treatment modality, timing of operation, age, H&H grade, Fisher grade, location and size of aneurysm and the cause of poor outcome was analyzed retrospectively with literature review. Statistical analysis was performed using paired t-test with SPSS Ver 10.0 and considered significant for value less than 0.05. RESULTS: There were stastistical significance between age, Fisher grade and outcome. Good outcome was obtained about 25.2% in early surgery group and 23.4% in delayed surgery group. Patients who did not undergo clipping presented very poor outcome. The causes of poor outcome mainly composed of delayed ischemic deficit(DID) from vasospasm and direct effect from SAH. CONCLUSION: To improve outcome in poor-grade SAH patients, there must be more intensive care preventing DID from vasospasm.