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Additional space-occupying intracerebral hematoma (ICH) in patients suffering from subarachnoid hemorrhage (SAH) is a known predictor for poor outcome. Emergent clot evacuation might be mandatory. However, data concerning the influence of ICH location on outcome is scarce. Therefore, we analyzed the influence of ICH location on clinical course and...
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... intracerebral hematoma (ICH) in patients suffering from subarachnoid hemorrhage (SAH) due to ruptured intra- cranial aneurysm is associated with poor neurological out- come [19]. Patients suffering from SAH and additional ICH usually present in a critical clinical condition [1,3,6,9,11,14,22,27]. Beside the initial brain damage, brain edema seems to be one cause of secondary deterioration and disability [15,27]. Mortality rates are higher compared to SAH patients without ICH and rise dramatically in conservative treatment strategies [9,16,18]. Therefore, initial clot evacuation and aneurysm occlusion seem mandatory [2,9,14,16,18,22,24,26], as favorable outcome can be achieved even in poor-grade patients ( Fig. 1) [11,17,21,25]. However, treatment strategies are still controversially discussed [6,17,24,25]. Several factors have been associated with favorable outcome, includ- ing young age, good admission status, and smaller volume of ICH [1,2,6,11,21,22]. However, data concerning the influence of the location of ICH location on outcome is scarce. We therefore analyzed our prospectively conducted neurovascular database of consecutive patients with aneurys- mal SAH and additional ICH, with special attention to the location of ...
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Background
Brain edema and/or acute hydrocephalus are common features that limit working space during early surgery of aneurysmal subarachnoid hemorrhage (aSAH). Intraoperative ventriculostomy offers an immediate brain relaxation. However, management and complications related to the routine use of intraoperative external ventricular drainage (iEVD)...
Background:
Little is known regarding functional outcome following poor-grade (World Federation of Neurosurgical Societies grades IV and V) aneurysmal subarachnoid hemorrhage (aSAH), especially in individuals treated aggressively in the early phase after ictus.
Methods:
We provided patients with aSAH with ultra-early definitive treatment, coilin...
Citations
... Although data regarding the risk factors for ICH and ISH formation remain controversial, the presence of these secondary hemorrhagic patterns has been associated with MCA aneurysm rupture as frequently as about one third of cases. [1][2][3] Furthermore, although in the case of a pure ICH, its evacuation will be desirable to obtain rapid brain decompression and improve brain perfusion, the removal of a large hematoma located in the sylvian fissure (i.e. , ISH) can result in the risk of vascular damage. Most investigators have usually reported its partial removal concurrent with aneurysm dissection and clipping. ...
... In the present study, we found that the presence of an associated intracranial hematoma significantly influenced the clinical severity after SAH in our series ( Table 1). Although its influence as an independent predictive factor of the final outcome was not confirmed on multivariate analysis ( Table 2), specifically for MCA aneurysms, this aspect has important epidemiological value because an ICH or ISH occurred in association with SAH from MCA aneurysm rupture in almost 44% of reported cases [1][2][3] and was 48% in our series. ...
Background:
Subarachnoid hemorrhage (SAH) due to a middle cerebral artery (MCA) aneurysms rupture is often associated with intracerebral (ICH) or intrasylvian hematomas (ISH).
Materials and methods:
We reviewed 163 patients with ruptured MCA aneurysms associated with pure SAH or SAH+ICH/ISH. Patients were first dichotomized according to the presence of a hematoma (ICH/ISH). Then, we performed a subgroup analysis comparing ICH versus ISH in order to explore their relationship with the most relevant demographic, clinical, and angioarchitectural features.
Results:
Overall, 85 patients (52%) had a pure SAH, whereas 78 (48%) presented an associated ICH/ISH. No significant differences were observed in demographics and angioarchitectural features between the two groups, but Fisher grading and Hunt-Hess score were higher in patients with hematomas. A good outcome was observed in a higher percentage of patients with pure SAH compared with the others (76% Vs 44%), although mortality rates were comparable. Age, Hunt-Hess and treatment-related complications were the main outcome predictors at multivariate analysis. Patients with ICH appeared clinically worse than those with ISH. We also found that older age, higher Hunt-Hess, larger aneurysms, decompressive craniectomy and treatment-related complications were associated with poor outcome among patients with ISH, but not with ICH, which appeared per se as a more severe clinical condition.
Conclusions:
Our study confirm that age, Hunt-Hess and treatment-related complications influence the outcome of patients with ruptured MCA aneurysms. However, in the subgroup analysis of patients with SAH associated with ICH or ISH, only the Hunt-Hess at onset appeared as an independent predictor of outcome.
... Although data regarding the risk factors of their formation remain controversial, the presence of these secondary hemorrhagic patterns is associated with MCA aneurysms rupture as frequently as about one-third out of cases [4,10,23]. Furthermore, whether in case of pure ICH its evacuation is desirable to obtain a rapid brain decompression improving the brain perfusion, the removal of a large hematoma located in the sylvian ssure (ISH) may expose to the risk of vascular damage. Most of the authors, in fact, usually report its partial removal aimed to aneurysm dissection and clipping. ...
... In this study, we found that the presence of an associated intracranial hematoma signi cantly in uenced the severity of the clinical picture after a SAH in our series (Table 1). Although its in uence as independent predictor of the nal outcome did not appear con rmed in the multivariate analysis (Table 2), in the speci c case of MCA aneurysms, this aspect has an important epidemiological value as an ICH or an ISH occur in association with SAH from MCA aneurysms rupture up to almost 44% out of cases in literature [4,10,23], and even 48% in our series. ...
Background
Subarachnoid hemorrhage (SAH) due to a middle cerebral artery (MCA) aneurysms rupture is often associated with intracerebral (ICH) or intrasylvian hematomas (ISH).
Materials and methods
We reviewed 163 patients with ruptured MCA aneurysms associated with pure SAH or SAH + ICH/ISH. Patients were first dichotomized according to the presence of a hematoma (ICH/ISH). Then, we performed a subgroup analysis comparing ICH versus ISH in order to explore their relationship with the most relevant demographic, clinical, and angioarchitectural features.
Results
Overall, 85 patients (52%) had a pure SAH, whereas 78 (48%) presented an associated ICH/ISH. No significant differences were observed in demographics and angioarchitectural features between the two groups, but Fisher grading and Hunt-Hess score were higher in patients with hematomas. A good outcome was observed in a higher percentage of patients with pure SAH compared with the others (76% Vs 44%), although mortality rates were comparable. Age, Hunt-Hess and treatment-related complications were the main outcome predictors at multivariate analysis. Patients with ICH appeared clinically worse than those with ISH. We also found that older age, higher Hunt-Hess, larger aneurysms, decompressive craniectomy and treatment-related complications were associated with poor outcome among patients with ISH, but not with ICH, which appeared per se as a more severe clinical condition.
Conclusions
Our study confirm that age, Hunt-Hess and treatment-related complications influence the outcome of patients with ruptured MCA aneurysms. However, in the subgroup analysis of patients with SAH associated with ICH or ISH, only the Hunt-Hess at onset appeared as an independent predictor of outcome.
... [2,22] Also, it further postulated that the anatomic direction of the aneurysm dome toward the cortex may contribute to the formation of ICH. [2,11,22] Interestingly, Bruder et al [23] did not find any association between ICH location and outcome of patients. Lok et al [24] observed that many factors namely age, individual brain compliance, location of the aneurysm, high blood pressure, and arteriosclerosis were also the contributing factors of poor-grade SAH. ...
Intracerebral hematoma (ICH) as a result of ruptured of intracranial aneurysms often arises in patients with subarachnoid hemorrhage. Few studies focused on risk factors for ICH and not the impact of residual hematoma after evacuation on the outcomes of the patients. Therefore, 2 questions need to be answered: does residual hematoma after evacuation have impact on the outcome of patients who present with ICH as a result of ruptured intracranial aneurysms? Is radical pursuit of the hematoma necessary?
The study was a single-center longitudinal observational type. Data of 2044 consecutive patients with subarachnoid hemorrhage from January 2009 to December 2019 were reviewed. ICHs were established and the locations of aneurysms as well as hematoma volumes were measured by computed tomographic scan before aneurysm occlusion. Only patients who received aneurysm clipping were included. Patients were stratified into hematoma evacuation without residuals versus residual hematoma after evaluation groups, and outcome was assessed according to the modified Rankin Scale (mRS) at 6 months.
Out of the 1365 patients who received clipping, 476 patients presented in poor grade, whereas 889 patients’ good grade. Our mRS scores revealed that patients who attained hematoma evacuation without residuals in the good-grade category attained better functional outcome than those with residual hematoma after evacuation. Contrarily, our mRS scores did not establish any significant difference in outcome between the poor-grade patients with hematoma evacuation without residuals and patients with residual hematoma after evacuation. Furthermore, our logistic regression model showed that advance age, poor Hunt-Hess grade, and vascular injury due to surgery were contributing factors for poor outcome of patients with ICH.
Our data suggested that aggressive hematoma evacuation may not benefit the poor-grade patients. Majority of poor outcomes were due to surgical complications which were vascular related as a result of excessive pursuit of ICH.
... In cases of DCI or delayed ischemic neurological deficit (DIND), induced hypertension with catecholamines was initiated [7]. Patients presenting with additional subdural hematoma or aneurysm related intracerebral hemorrhage were treated surgically [8,9]. In cases of refractory elevated intracranial pressure, decompressive hemicraniectomy was performed as previously described [10]. ...
Acute kidney injury (AKI) is a known predictor of unfavorable outcome in patients treated at the ICU, irrespective of the disease. However, data on the potential influence of serum creatinine (sCr) on hospital admission on the outcome in patients suffering from aneurysmal subarachnoid hemorrhage (SAH) is scarce. A total of 369 consecutive patients suffering from SAH were included in this retrospective cohort study. Patients were divided into good-grade (WFNS I–III) versus poor-grade (WFNS IV–V). Outcome was assessed according to the modified Rankin Scale (mRS) after 6 months and stratified into favorable (mRS 0–2) versus unfavorable (mRS 3–6). SAH patients with sCr levels <1.0 mg/dL achieved significantly a favorable outcome more often compared to patients with sCr levels ≥1.0 mg/dL (p = 0.003). In the multivariable analysis, higher levels of sCr (p = 0.014, OR 2.4; 95% CI 1.2–4.7), poor-grade on admission (p < 0.001, OR 9.8; 95% CI 5.6–17.2), age over 65 years (p < 0.001, OR 3.3; 95% CI 1.7–6.1), and delayed cerebral ischemia (p < 0.001, OR 7.9; 95% CI 3.7–17.1) were independently associated with an unfavorable outcome. We identified increased sCr on admission as a predictor for unfavorable functional outcome after SAH. Further studies elucidating the pathophysiology of this association are necessary.
... Spontaneous intracerebral hemorrhage can have a wide variety of underlying causes [10][11][12][13][14] However, the common denominator is that the ICH is an unexpected and devastating event in the lives of affected patients due to the sudden bleeding event [15]. Due to this unpredictability, treating physicians also regularly encounter a problem in patients with ICH that is well known from other areas of intensive care/emergency medicine: an expression of the specific patient's will is oftentimes not possible or not reliable due to the severity of the disease and/or neurological deficits [9,16]. ...
Background and Objectives: Treatment-limiting decisions (TLDs) are employed to actively withhold treatment/invasive interventions from patients in whom clinicians feel they would derive little to no benefit and/or suffer detrimental effects. Data regarding the employment of TLDs in patients with spontaneous intracerebral hemorrhage (ICH) remain sparse. Accordingly, this study sought to investigate both the prevalence of TLDs and factors driving TLDs in patients suffering from spontaneous ICH. Materials and Methods: This was a retrospective study of 249 consecutive patients with ICH treated from 2018–2019 at the Neurovascular Center of the University Hospital Bonn. Reasons deemed critical in the decision-making process with regard to TLD were ultimately extracted/examined via chart review of qualifying patients. Results: A total of 249 patients with ICH were included within the final analyses. During the time period examined, 49 patients (20%) had advanced directives in place, whereas in 53 patients (21%) consultation with relatives or acquaintances was employed before further treatment decisions. Overall, TLD ultimately manifested in 104 patients (42%). TLD was reached within 6 h after admission in 52 patients (50%). Congruent with severity of injury and expected outcomes, TLDs were more likely in patients with signs of cerebral herniation and an ICH score > 3 (p < 0.001). Conclusions: The present study examines details associated with TLDs in patients with spontaneous ICH. These data provide insight into key decisional processes and reinforce the need for further structured investigations in an effort to help guide patients and their families.
... (Guresir et al., 2008, Wan et al., 2016. Vergleichsweise ungünstig erwiesen sich insbesondere große ICB mit einem Volumen über 50 ml (Bruder et al., 2014, Guresir et al., 2008, Jabbarli et al., 2016. ...
... Im Wesentlichen stützen die Befunde der vorliegenden Studie frühere Ergebnisse (Bruder et al., 2014, Hauerberg et al., 1994, Tokuda et al., 1995, Wan et al., 2016, wonach das Auftreten intrazerebraler Blutanteile eher von aneurysmaspezifischen Faktoren abhängt und weniger auf Merkmale oder Vorerkrankungen des Patienten zurückzuführen ist. ...
... Darüber hinaus wurde in einigen Studien ein höheres Risiko für Rezidivblutungen (Guresir et al., 2008, Naidech et al., 2005, van Donkelaar et al., 2015, DCI (Platz et al., 2017) und für einen Hydrozephalus (Niikawa et al., 1998) Monaten zu einem weniger günstigen Outcome neigen (Bruder et al., 2014, Tokuda et al., 1995, Wan et al., 2016. Die Mortalität lag in diesen Kohorten im Mittel doppelt so hoch wie bei jenen ohne ICB (Guresir et al., 2008, Wan et al., 2016 ...
Hintergrund und Ziele: Subarachnoidalblutungen (SAB) gehen nicht selten mit intrazerebralen Blutanteilen (ICB) einher, welche den klinischen Zustand und Krankheitsverlauf zusätzlich beeinträchtigen können. Die Bedeutung begleitender ICB für das langfristige Outcome ebenso wie ihre Behandlung blieben bislang jedoch im Wesentlichen ungeklärt. Zwar empfehlen die aktuellen Leitlinien bei massenwirksamen Blutungen eine chirurgische Hämatomevakuation (CHE), die Evidenz für dieses Vorgehen ist allerdings limitiert. Methoden: Retrospektiv ausgewertet wurden die Daten von allen konsekutiven Patienten, welche in einem Zeitraum von 5 Jahren (2008–2012) aufgrund einer atraumatischen SAB in der Neurologischen und Neurochirurgischen Klinik des Universitätsklinikums Erlangen behandelt worden sind. Neben klinischen Parametern und dem Ausmaß der SAB wurden die Häufigkeit und Lokalisation von ICB erfasst und ihr Volumen anhand der ABC/2-Formel abgeschätzt. Die Beurteilung des Outcomes nach 12 Monaten umfasste funktionelle Einschränkungen (modified Rankin Scale (mRS)), die gesundheitsbezogene Lebensqualität (EQ-5D-VAS) sowie Langzeitkomplikationen (u.a. Epilepsie). Zur besseren Vergleichbarkeit von Patienten mit und ohne ICB wurde ein Propensity Score Matching (PSM; Ratio 1:1, Caliper 0,1) durchgeführt. Ferner erfolgten Subanalysen, um den Einfluss verschiedener Behandlungsverfahren (chirurgische Hämatomevakuation versus konservative Behandlung) auf das Outcome zu überprüfen. Ergebnisse und Beobachtungen: Von insgesamt 494 Patienten mit atraumatischer SAB wiesen initial 85 (17,2 %) Patienten intrazerebrale Blutanteile auf. Diese hatten zum Zeitpunkt der Aufnahme einen schlechteren klinischen Zustand und ein größeres Ausmaß subarachnoidaler und intraventrikulärer Blutanteile (IVB) (mFisher, Median (IQR): ICB 3 (2–4) vs. ØICB 2 (1– 3); p = 0,001; IVB: ICB 74,1 % vs. ØICB 57,0 %; p = 0,004; Graeb Score, Median (IQR): ICB 4 (2–8) vs. ØICB 2,5 (2–4); p < 0,001)). Das mediane intrazerebrale Blutvolumen betrug 11,0 (5,4–31,8) ml, wobei die größten ICB-Volumina mit rupturierten Aneurysmen der Arteria cerebri media (MCA) verbunden waren (31,6 ml (16,3–43,2)). Nach Adjustierung mittels PSM erlangten ICB-Patienten nicht nur seltener ein günstiges funktionelles Outcome (mRS 0–2: ICB 31,8 % vs. ØICB 57,7 %; p < 0,001), sie litten auch häufiger an einer Epilepsie (ICB 23,4 % vs. ØICB 7,3 %; p = 0,03), konnten seltener beruflich wiedereingegliedert werden (ICB 12,7 % vs. ØICB 32,1 %; p = 0,008) und schätzten ihre eigene Gesundheit schlechter ein (EQ-5D-VAS: ICB 50 (30–70) vs. ØICB 80 (65–95); p < 0,001). Die Behandlung mit einer chirurgischen Hämatomevakuation, ungeachtet des Alters oder der Aneurysmalokalisation, war häufiger mit einem günstigen Outcome nach 12 Monaten assoziiert als eine konservative Behandlung (CHE 14/28 (50,0 %) vs. konservativ 14/57 (24,6 %); adjustierte Odds Ratio (OR, 95 % KI): 1,34 (1,08–1,66); p = 0,001). Dieser Vorteil zeigte sich den Subgruppen- Analysen nach insbesondere für Patienten mit frontal lokalisierten ICB (OR 1,59 (1,14– 2,23)), großen ICB-Volumina (> 10 ml; OR 1,39 (1,09–1,79)) und bei Patienten, die frühzeitig einer CHE unterzogen wurden (≤ 600 min nach Blutungsbeginn; OR 1,42 (1,03–1,94)). Schlussfolgerungen: Intrazerebrale Blutanteile sind häufige Komplikationen einer SAB, die gravierende funktionelle sowie subjektive Einschränkungen nach sich ziehen. Möglicherweise könnten diese Patienten von einer frühzeitigen chirurgischen Hämatomevakuation profitieren.
... A cerebral digital subtraction angiography (DSA) was performed within 12 h after admission. If DSA revealed an intracranial aneurysm as bleeding source, treatment decision (endovascular or microsurgery) was based on an interdisciplinary approach in each individual case, as previously reported [1,2,19]. If no bleeding source was detected by first angiography, MRI of the spine was performed to rule out any bleeding sources in this region. ...
Acetylsalicylic acid (ASA) is a well-known and widely used analgesic for acute pain. Patients with acute headache due to subarachnoid hemorrhage (SAH) are inclined to take ASA in this situation. Due to the antithrombotic effects, ASA intake is related to higher bleeding rates in case of hemorrhage or surgical treatment. Between January 2006 and December 2016, 941 patients without continuous antithrombotic or anticoagulant medication were treated due to SAH in our institution. Fourteen of them (1.5%) had taken ASA as a single dose because of headache within 24 h before hospital admission. A matched pair analysis was performed. Admission status was good in 93% of patients with one-time use of ASA (OTA), but only in 59% of all other patients (p < 0.01). Bleeding pattern did not differ, but half of the patients with OTA had no identifiable bleeding source; this rate was significantly lower in the rest of the patients (p < 0.005). Aneurysm treatment and related complications did not differ between both groups. Cerebral vasospasm was more often only mild and rates of cerebral infarctions were lower in the OTA group but not on a significant level. Eighty-six percent of the OTA group and 84% (p = 0.8) of the matched pair control group reached favorable outcome according to mRS 6 months after SAH. Patients with OTA in case of SAH are usually in good clinical condition and bleeding pattern does not differ. In half of the patients with OTA, no bleeding source was detectable. In the case of aneurysm treatment, related complications did not differ and most of the patients reached favorable outcome. In the case of aneurysm treatment procedure, OTA does not influence treatment course and should not influence treatment decisions.
... Studies showed that space-occupying ICH secondary to aSAH typically leads to an unfavorable outcome [22,25,30,31]. Beyond that, volume of secondary ICH also correlated significantly with outcome [30,32]. A noticeably higher mortality was observed in aSAH patients with ICH volume above 50 cm 3 [30]. ...
Purpose:
Despite its high prevalence among patients with aneurysmal subarachnoid hemorrhage (aSAH) and high risk of delayed cerebral ischemia (DCI), the Fisher grade 3 category remains a poorly studied subgroup. The aim of this cohort study has been to investigate the prognostic value of the Hijdra sum scoring system for the functional outcome in patients with Fisher grade 3 aSAH, in order to improve the risk stratification within this Fisher category.
Methods:
Initial CT scans of 72 prospectively enrolled patients with Fisher grade 3 aSAH were analyzed, and cisternal, ventricular, and total amount of blood were graded according to the Hijdra scale. Additionally, space-occupying subarachnoid blood clots were assessed. Outcome was evaluated after 6 months.
Results:
Within the subgroup of Fisher grade 3, aSAH patients with an unfavorable outcome showed a significantly larger cisternal Hijdra sum score (HSS: 21.1 ± 5.2) than patients with a favorable outcome (HSS: 17.6 ± 5.9; p = 0.009). However, both the amount of ventricular blood (p = 0.165) and space-occupying blood clots (p = 0.206) appeared to have no prognostic relevance. After adjusting for the patient's age, gender, tobacco use, clinical status at admission, and presence of intracerebral hemorrhage, the cisternal and total HSS remained the only independent parameters included in multivariate logistic regression models to predict functional outcome (p < 0.01).
Conclusion:
The cisternal Hijdra score is fairly easy to perform and the present study indicates that it has an additional predictive value for the functional outcome within the Fisher 3 category. We suggest that the Hijdra scale is a practically useful prognostic instrument for the risk evaluation after aSAH and should be applied more often in the clinical setting.
... Furthermore, presence or absence of ICH and IVH is not included in the BNI scale but may be relevant factors for patient outcome. 6,11,[14][15][16][17][18] We therefore designed a study aiming to address the question of whether BNI grading is reliable in the prediction of new CI and clinical outcome and if other pathological findings on CT such as ICH or IVH may be independent risk factors. Moreover, we aimed to compare the BNI scale with validated clinical grading systems. ...
... [29][30][31] Location of the hematoma was not shown to have a substantial impact on patient outcome. 15 IVH was proved to be a relevant condition determining presence of vasospasm, CI, and patient outcome in several studies. [32][33][34][35][36] ...
... We neither quantified ICH and IVH nor did we categorize them according to their location as proposed by other colleagues. 15,47,48 While these grading systems do have their scientific merits, none of them is intuitively applicable at the bedside and did gain widespread clinical use. ...
BACKGROUND: In 2012, a new computed tomography (CT) grading scale was introduced by the Barrow Neurological Institute group (“BNI scale”) to predict angiographic and symptomatic vasospasm in aneurysmal subarachnoid hemorrhage.
OBJECTIVE: To address the question of whether BNI grading is reliable in the prediction of cerebral infarction and clinical outcome and to compare BNI scores to existing radiographic and clinical models of outcome prediction.
METHODS: Consecutive data of 260 patients with aneurysmal subarachnoid hemorrhage was retrospectively analyzed with respect to radiographic and clinical parameters.
RESULTS: Patients presenting with more severe BNI grades were older (P = .002), displayed lower Glasgow Coma Scale scores at admission (P < .001) and were more often diagnosed with intraventricular hemorrhage (P < .001). An increasing BNI grade was associated with higher rates of severe angiographic vasospasm (P = .007), the occurrence of new cerebral infarction (P < .001), and poor patient outcome (P < .001). In contrast, analysis according to the Fisher grading system did not show a significant relationship to any outcome parameter. Multivariate analysis combining radiographic and clinical parameters showed significant results for clinical scores (Hunt and Hess and World Federation of Neurosurgical Societies) with radiographic information losing its predictive capability.
CONCLUSION: The BNI scale is easily applicable and superior to the original Fisher scale regarding prediction of angiographic vasospasm, new cerebral infarction, and patient outcome. Presence of intraventricular hemorrhage and intracerebral hemorrhage are additional radiographic factors with outcome relevance that are not part of the BNI scale. Established clinical scores like World Federation of Neurosurgical Societies and Hunt and Hess grading were more relevant for outcome prediction than any radiographic information.
... Although the impact of ICH on treatment and outcome of SAH has been studied often, 1,4,7,12,13,15,24,[26][27][28]33,39 data on the prediction of DCI due to ICH are very limited. 12 The presence of ICH was not assessed in detail in the mFS. ...
OBJECTIVE
Delayed cerebral ischemia (DCI) has a major impact on the outcome of patients suffering from aneurysmal subarachnoid hemorrhage (SAH). The aim of this study was to assess the influence of an additional intracerebral hematoma (ICH) on the occurrence of DCI.
METHODS
The authors conducted a single-center retrospective analysis of cases of SAH involving patients treated between 2006 and 2011. Patients who died or were transferred to another institution within 10 days after SAH without the occurrence of DCI were excluded from the analysis.
RESULTS
Additional ICH was present in 123 (24.4%) of 504 included patients (66.7% female). ICH was classified as frontal in 72 patients, temporal in 24, and perisylvian in 27. DCI occurred in 183 patients (36.3%). A total of 59 (32.2%) of these 183 patients presented with additional ICH, compared with 64 (19.9%) of the 321 without DCI (p = 0.002). In addition, DCI was detected significantly more frequently in patients with higher World Federation of Neurosurgical Societies (WFNS) grades.
The authors compared the original and modified Fisher Scales with respect to the occurrence of DCI. The modified Fisher Scale (mFS) was superior to the original Fisher Scale (oFS) in predicting DCI. Furthermore, they suggest a new classification based on the mFS, which demonstrates the impact of additional ICH on the occurrence of DCI.
After the different scales were corrected for age, sex, WFNS score, and aneurysm site, the oFS no longer was predictive for the occurrence of DCI, while the new scale demonstrated a superior capacity for prediction as compared with the mFS.
CONCLUSIONS
Additional ICH was associated with an increased risk of DCI in this study. Furthermore, adding the presence or absence of ICH to the mFS improved the identification of patients at the highest risk for the development of DCI. Thus, a simple adjustment of the mFS might help to identify patients at high risk for DCI.
