Clinical condition of 120 patients alive at 3 years after poor-grade aneurysmal subarachnoid hemorrhage

Abstract Background To study the clinical condition of poor-grade aneurysmal subarachnoid hemorrhage (aSAH) patients alive at 3 years after neurointensive care. Methods Of the 769 consecutive aSAH patients from a defined population (2005–2015), 269 (35%) were in poor condition on admission: 145 (54%) with H&H 4 and 124 (46%) with H&H 5. Their clinical lifelines were re-constructed from the Kuopio Intracranial Aneurysm Database and Finnish nationwide registries. Of the 269 patients, 155 (58%) were alive at 14 days, 125 (46%) at 12 months, and 120 (45%) at 3 years. Results The 120 H&H 4–5 patients alive at 3 years form the final study population. On admission, 73% had H&H 4 but only 27% H&H 5, 59% intracerebral hematoma (ICH; median 22 cm3), and 26% intraventricular blood clot (IVH). The outcome was favorable (mRS 0–1) in 45% (54 patients: ICH 44%; IVH clot 31%; shunt 46%), moderate (mRS 2–3) in 30% (36 patients: ICH 64%; IVH clot 19%; shunt 42%), and unfavorable (mRS 4–5) in 25% (30 patients: ICH 80%; IVH clot 23%; shunt 50%). A total of 46% carried a ventriculoperitoneal shunt. ICH volume was a significant predictor of mRS at 3 years. Conclusions Of poor-grade aSAH patients, 45% were alive at 3 years, even 27% of those extending to pain (H&H 5). Of the survivors, 75% were at least in moderate condition, while only 2.6% ended in hospice care. Consequently, we propose non-selected admission to neurointensive care (1) for a possibility of moderate outcome, and (2), in case of brain death, possibly improved organ donation rates.

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SUBARACHNOID HEMORRHAGE AND INTRACEREBRAL HEMATOMA

Neurosurgery ◽

10.1227/01.neu.0000335170.76722.b9 ◽

2008 ◽

Vol 63 (6) ◽

pp. 1088-1094 ◽

Cited By ~ 79

Author(s):

Erdem Güresir ◽

Jürgen Beck ◽

Hartmut Vatter ◽

Matthias Setzer ◽

Rüdiger Gerlach ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Odds Ratio ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Favorable Outcome ◽

Intracerebral Hematoma ◽

Modified Rankin Scale ◽

Poor Grade ◽

Hematoma Evacuation ◽

Number Of Patients ◽

Good Grade

Abstract OBJECTIVE To analyze the incidence and impact of an intracerebral hematoma (ICH) on treatment and outcome in patients with aneurysmal subarachnoid hemorrhage. METHODS Data of 585 consecutive patients with subarachnoid hemorrhage from June 1999 to December 2005 were prospectively entered in a database. ICH was diagnosed and size was measured by computed tomographic scan before aneurysm occlusion. Fifty patients (8.5%) presented with an ICH larger than 50 cm3. The treatment decision (coil, clip, or hematoma evacuation) was based on an interdisciplinary approach. Patients were stratified into good (Hunt and Hess Grades I–III) versus poor (Hunt and Hess Grades IV and V) grade, and outcome was assessed according to the modified Rankin Scale at 6 months. RESULTS Overall, 358 patients presented in good grade, with 4 of them having ICH (1.1%); and 227 patients presented in poor grade, with 46 of them having ICH (20.3%, P < 0.01). In good-grade patients with an ICH (n = 4), a favorable outcome (modified Rankin Scale score of 0–2) was achieved in 1 patient (25%), and in 246 patients (75%) without an ICH (P = 0.053; odds ratio, 0.11). A favorable outcome was achieved in 5 poor-grade patients (12.8%) with an ICH and in 40 patients (23.7%) without an ICH (P = 0.19; odds ratio, 0.47). Time to treatment was significantly shorter in patients with an ICH than without an ICH (median, 7 versus 26 h; P < 0.001) and shortest in patients with favorable outcome (3.5 hours; P < 0.01). CONCLUSION The current data confirm that the presence of an ICH is a predictor of unfavorable outcome. However, despite large ICHs, a significant number of patients have a good outcome. To achieve a favorable outcome, ultra-early treatment with hematoma evacuation and aneurysm obliteration seems to be mandatory.

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Apolipoprotein E genotype and outcome after aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2008.11.jns081266 ◽

2009 ◽

Vol 110 (5) ◽

pp. 989-995 ◽

Cited By ~ 21

Author(s):

Seppo Juvela ◽

Jari Siironen ◽

Jaakko Lappalainen

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Cerebral Infarction ◽

Apolipoprotein E ◽

Clinical Condition ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Univariate Analysis ◽

Delayed Cerebral Ischemia ◽

Intracerebral Hematoma ◽

Poor Outcome

Object After aneurysmal subarachnoid hemorrhage (SAH), conflicting results concerning an association between the APOE genotype and impaired outcome have been reported. The authors tested prospectively whether APOE ε2 or ε4 allele–containing genotypes (ε2+ and ε4+) affect outcome after SAH. Methods Previous disease histories and clinical and radiological variables were recorded for 105 patients who were admitted within 48 hours after SAH. Fifteen patients (14%) had the ε2+ genotype and 31 (17%) had ε4+ genotypes. Factors predicting poor outcome according to the Glasgow Outcome Scale and cerebral infarction visible on CT scans obtained at 3 months after SAH were tested with multiple logistic regression analyses. Results Apolipoprotein E ε2 or ε4–containing genotypes were not associated with outcome, occurrence of cerebral infarction, or with any of their predictors, either in univariate or multivariate analysis. Poor outcome was predicted independently by the occurrence of intraventricular bleeding and intracerebral hematoma as well as by elevated levels of both plasma glucose and D-dimer, and delayed cerebral ischemia (p < 0.05 for each factor), and in univariate analysis only by clinical condition on admission and patient age. Cerebral infarction was predicted independently according to clinical condition on admission (p < 0.05), amount of subarachnoid blood (p < 0.01), duration of intraoperative parent artery clipping (p < 0.01), and body mass index (p < 0.05). In the univariate analysis only cerebral infarction was also predicted by patient age, intracerebral hematoma, and delayed cerebral ischemia. Conclusions Severity of bleeding for the most part predicts outcome after SAH; APOE polymorphisms seem to have no prognostic value for outcome after SAH. This result was in accordance with the findings from the largest ischemic stroke studies.

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Faculty Opinions recommendation of Cerebral Autoregulation in the Prediction of Delayed Cerebral Ischemia and Clinical Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage Patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.732595998.793542399 ◽

2018 ◽

Author(s):

Stephan Mayer

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Ischemia ◽

Clinical Outcome ◽

Cerebral Autoregulation ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Delayed Cerebral Ischemia ◽

Poor Grade

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Letter: Predicting Long-Term Outcomes After Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Decision Tree Modeling

Neurosurgery ◽

10.1093/neuros/nyaa511 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jaskaran Singh Gosal ◽

Kuntal Kanti Das ◽

Deepak Khatri ◽

Kamlesh Singh Bhaisora ◽

Sanjay Behari

Keyword(s):

Subarachnoid Hemorrhage ◽

Decision Tree ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Long Term Outcomes ◽

Poor Grade ◽

Tree Modeling

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Decompressive Surgery in Patients with Poor-grade Aneurysmal Subarachnoid Hemorrhage: Clipping with Simultaneous Decompression Versus Coil Embolization Followed by Decompression

Journal of Cerebrovascular and Endovascular Neurosurgery ◽

10.7461/jcen.2014.16.3.254 ◽

2014 ◽

Vol 16 (3) ◽

pp. 254 ◽

Cited By ~ 13

Author(s):

Ui Seung Hwang ◽

Hee Sup Shin ◽

Seung Hwan Lee ◽

Jun Seok Koh

Keyword(s):

Subarachnoid Hemorrhage ◽

Coil Embolization ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Decompressive Surgery ◽

Poor Grade

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Continuous monitoring of cerebrovascular autoregulation for the poor grade patients after aneurysmal subarachnoid hemorrhage

Cerebral Blood Flow and Metabolism (Japanese journal of cerebral blood flow and metabolism) ◽

10.16977/cbfm.25.2_31 ◽

2014 ◽

Vol 25 (2) ◽

pp. 31-36

Author(s):

Hiroyasu Koizumi ◽

Kazutaka Sugimoto ◽

Satoshi Shirao ◽

Hideyuki Ishihara ◽

Hirokazu Sadahiro ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Continuous Monitoring ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Poor Grade ◽

Cerebrovascular Autoregulation ◽

The Poor

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The venous delay phenomenon in computed tomography angiography: a novel imaging outcome predictor for poor cerebral perfusion after severe aneurysmal subarachnoid hemorrhage

Journal of Neurosurgery ◽

10.3171/2017.5.jns17794 ◽

2018 ◽

Vol 129 (4) ◽

pp. 876-882 ◽

Cited By ~ 1

Author(s):

Po-Chuan Hsieh ◽

Yi-Ming Wu ◽

Alvin Yi-Chou Wang ◽

Ching-Chang Chen ◽

Chien-Hung Chang ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Perfusion ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Multivariable Analysis ◽

Outcome Predictor ◽

Treatment Results ◽

Tertiary Referral Center ◽

Poor Grade ◽

Poor Outcome ◽

Delay Phenomenon

OBJECTIVEDiverse treatment results are observed in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). Significant initial perfusion compromise is thought to predict a worse treatment outcome, but this has scant support in the literature. In this cohort study, the authors correlate the treatment outcomes with a novel poor-outcome imaging predictor representing impaired cerebral perfusion on initial CT angiography (CTA).METHODSThe authors reviewed the treatment results of 148 patients with poor-grade aSAH treated at a single tertiary referral center between 2007 and 2016. Patients with the “venous delay” phenomenon on initial CTA were identified. The outcome assessments used the modified Rankin Scale (mRS) at the 3rd month after aSAH. Factors that may have had an impact on outcome were retrospectively analyzed.RESULTSCompared with previously identified outcome predictors, the venous delay phenomenon on initial CTA was found to have the strongest correlation with posttreatment outcomes on both univariable (p < 0.0001) and multivariable analysis (OR 4.480, 95% CI 1.565–12.826; p = 0.0052). Older age and a higher Hunt and Hess grade at presentation were other factors that were associated with poor outcome, defined as an mRS score of 3 to 6.CONCLUSIONSThe venous delay phenomenon on initial CTA can serve as an imaging predictor for worse functional outcome and may aid in decision making when treating patients with poor-grade aSAH.

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