Management Outcome of Poor Grade Patients with Aneurysmal Subarachnoid Hemorrhage.
- Author:
Young Jin SONG
1
;
Jae Taeck HUH
;
Chul Min CHO
Author Information
1. Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea.
- Publication Type:Original Article
- Keywords:
Poor grade patient;
Management outcome;
Early surgery;
Delayed surgery;
Subarachnoid hemorrhage
- MeSH:
Aneurysm*;
Hemorrhage;
Humans;
Mortality;
Subarachnoid Hemorrhage*
- From:Journal of Korean Neurosurgical Society
2002;31(4):325-330
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: The aim of this study is to determine the treatment strategies for the poor grade patients with aneurysmal subarachnoid hemorrhage(SAH) with respect to the timing of surgery. METHODS: We have analyzed 51 patients of Hunt and Hess grade IV and V at admission among 140 SAH patients who were managed during recent three years. They were devided into two groups according to the interval between SAH and surgery: 30 early treatment group(operated within 3 days) and 21 delayed treatment group(6 delayed operation cases and 15 unoperated cases). RESULTS: Clinical outcome of early surgery group was favorable(Good or Fair) in 23 cases(76.7%) and unfavorable in 7 cases(23.3%, 2 Poor, 5 Dead). On the contrary, those of delayed surgery group or without surgery group was favorable in 4 cases(19.1%) and unfavorable in 17 cases(80.9%, 1 Poor, 16 Dead). Overall management outcome of poor grade SAH patients was favorable in 27 cases(52.9%), unfavorable in 24 cases(47.1%) and mortality rate was 41.2%. Unfavorable outcome in poor grade SAH patients was largely affected by the initial hemorrhage and subsequent development of intractable intracranial hypertension(Hunt and Hess grade IV: 5 cases, grade V: 8 cases), cerebral infarction(grade IV: 3 cases, grade V: 1), rebleeding(grade IV: 3 cases), and surgical complication(4 cases). CONCLUSION: An active treatment policy including early surgery might achieve a better outcome of poor grade SAH patients.
