scholarly journals Poor-Grade Aneurysmal Subarachnoid Hemorrhage: Diagnosis, Therapeutical Management, and Prognosis

2020 ◽  
Author(s):  
Bing Zhao ◽  
Haixia Xing ◽  
Shenghao Ding ◽  
Yaohua Pan ◽  
Jieqing Wan
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Poor Grade

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

2021 ◽  
Author(s):  
Anniina H. Autio ◽  
Juho Paavola ◽  
Joona Tervonen ◽  
Maarit Lång ◽  
Terhi J. Huuskonen ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Condition ◽  
Hospice Care ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Blood Clot ◽  
Neurointensive Care ◽  
Intracerebral Hematoma ◽  
Poor Grade ◽  
Final Study ◽  
Study Population

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.

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

2018 ◽  
Vol 129 (4) ◽  
pp. 876-882 ◽  
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.

Hemorrhagic burden in poor-grade aneurysmal subarachnoid hemorrhage: a volumetric analysis of different bleeding distributions

2019 ◽  
Vol 161 (4) ◽  
pp. 791-797
Author(s):  
Pietro Panni ◽  
Elisa Colombo ◽  
Carmine Antonio Donofrio ◽  
Lina Raffaella Barzaghi ◽  
Luigi Albano ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Volumetric Analysis ◽  
Poor Grade

scholarly journals Intrasylvian hematoma caused by ruptured middle cerebral artery aneurysms predicts recovery from poor-grade subarachnoid hemorrhage

2015 ◽  
Vol 123 (3) ◽  
pp. 686-692 ◽  
Author(s):  
Hitoshi Fukuda ◽  
Kosuke Hayashi ◽  
Takafumi Moriya ◽  
Satoru Nakashita ◽  
Benjamin W. Y. Lo ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Multivariable Analysis ◽  
World Federation ◽  
Poor Grade ◽  
Younger Age ◽  
Scale Scores ◽  
Cisternal Irrigation ◽  
Observational Cohort ◽  
Middle Cerebral Artery Aneurysms

OBJECT Intrasylvian hematoma (ISH) is a subtype of intracranial hematoma caused by aneurysmal rupture and often presents with a poor initial neurological grade; it is not well studied. The aim of this study was to elucidate outcomes of aneurysmal subarachnoid hemorrhage (SAH) with ISH. METHODS Data for 97 patients with poor-grade SAH (World Federation of Neurosurgical Societies Grade IV or V) were retrospectively analyzed from a single-center, prospective, observational cohort database. Ultra-early surgical clipping, removal of hematoma, external decompression for brain swelling, and prevention of vasospasm by cisternal irrigation with milrinone were combined as an aggressive treatment. Characteristics and clinical courses of SAH with ISH were identified. The authors also evaluated any correlations between poor admission-grade SAH and ISH with good functional outcome. RESULTS Patients with poor admission-grade SAH and with ISH were more likely to have initial cerebral edema (p < 0.001, Mann-Whitney U-test), which significantly resolved overtime (p < 0.001, Mann-Whitney U-test). These patients had a better chance of functional survival (modified Rankin Scale scores of 1–3; OR 5.75; 95% CI 1.36–24.3; p = 0.017) at 6 months after hospital discharge, after adjustment for potential confounders such as younger age and better initial neurological grade by multivariable analysis. CONCLUSIONS ISH predicted good functional recovery from poor-grade aneurysmal SAH.

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