Outcome evaluation following subarachnoid hemorrhage

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  • 1 Departments of Neurosurgery, Psychiatry, and Neurology, University Hospital, Lund, Sweden
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✓ Seventy-eight individuals among a population of 1.46 million suffered aneurysmal subarachnoid hemorrhage (SAH) during 1983. Within 24 hours after the bleed, 32 of the 78 patients were in Hunt and Hess neurological Grades I to II, 13 were in Grade III, 21 were in Grades IV to V, and 12 were dead on admission to a hospital or forensic department. When the amount of blood visualized on computerized tomography (CT) scanning was integrated with the Hunt and Hess neurological classification in order to improve prediction of prognosis, only 16 patients were considered to have a good prognosis (CT-modified Grades I to II), 21 had a less favorable prognosis (CT-modified Grade III), and 29 had a poor prognosis (CT-modified Grades IV to V).

Assessment at 1 year revealed that only 32 patients (41%) had a good physical recovery. The physical morbidity rate was 22%, and the overall mortality rate was 37%. Twenty-six individuals with a good neurological outcome and five with a fair outcome also underwent reexamination 1 year or more post-SAH, which included a comprehensive evaluation of the quality of life, assessment of cognitive dysfunction, and determination of general adjustment. Five of the patients with a good neurological outcome and all five with a fair outcome (four of whom had had a poor prognosis in the acute stage) showed severe psychosocial and cognitive incapacitation. When functional morbidity, based upon persistent severe cognitive and psychosocial impairment, was included in the outcome assessment, only 33% of the total series was considered to have a favorable outcome. Approximately 60% of the initially good-risk patients (Grades I and II) showed a good physical outcome without concomitant indications of severe cognitive dysfunction and/or psychosocial impairment. Among the good-risk patients with a CT-modified grade, the figure was 70%. It is suggested that in any outcome grading system, persistent cognitive and psychosocial disturbances be taken into account.

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Contributor Notes

Address reprint requests to: Bengt Ljunggren, M.D., Department of Neurosurgery, University Hospital, S-221 85 Lund, Sweden.
  • 1.

    Auer LM: Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:5766, 1984 Auer LM: Acute operation and preventive nimodipine improve outcome in patients with ruptured cerebral aneurysms. Neurosurgery 15:57–66, 1984

    • Search Google Scholar
    • Export Citation
  • 2.

    Bell BA, , Kendall BE, & Symon L: Computed tomography in aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 43:522524, 1980 Bell BA, Kendall BE, Symon L: Computed tomography in aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 43:522–524, 1980

    • Search Google Scholar
    • Export Citation
  • 3.

    Bond MR: Assessment of the psychosocial outcome of severe head injury. Acta Neurochir 34:5770, 1976 Bond MR: Assessment of the psychosocial outcome of severe head injury. Acta Neurochir 34:57–70, 1976

    • Search Google Scholar
    • Export Citation
  • 4.

    Bond MR, & Brooks DN: Understanding the process of recovery as a basis for the investigation of rehabilitation for the brain injured. Scand J Rehabil Med 8:127133, 1976 Bond MR, Brooks DN: Understanding the process of recovery as a basis for the investigation of rehabilitation for the brain injured. Scand J Rehabil Med 8:127–133, 1976

    • Search Google Scholar
    • Export Citation
  • 5.

    Botterell EH, , Lougheed WM, & Scott JW, et al: Hypothermia, and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms. J Neurosurg 13:142, 1956 Botterell EH, Lougheed WM, Scott JW, et al: Hypothermia, and interruption of carotid, or carotid and vertebral circulation, in the surgical management of intracranial aneurysms. J Neurosurg 13:1–42, 1956

    • Search Google Scholar
    • Export Citation
  • 6.

    Brooks DN, & McKinlay W: Personality and behavioural change after severe blunt head injury — a relative's view. J Neurol Neurosurg Psychiatry 46:336344, 1983 Brooks DN, McKinlay W: Personality and behavioural change after severe blunt head injury — a relative's view. J Neurol Neurosurg Psychiatry 46:336–344, 1983

    • Search Google Scholar
    • Export Citation
  • 7.

    Bryan RN, , Shah CP, & Hilal S: Evaluation of subarachnoid hemorrhage and cerebral vasospasm by computed tomography. CT 3:144152, 1979 Bryan RN, Shah CP, Hilal S: Evaluation of subarachnoid hemorrhage and cerebral vasospasm by computed tomography. CT 3:144–152, 1979

    • Search Google Scholar
    • Export Citation
  • 8.

    Davis JM, , Davis KR, & Crowell RM: Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm: prognostic significance of cranial CT. AJR 134:711715, 1980 Davis JM, Davis KR, Crowell RM: Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm: prognostic significance of cranial CT. AJR 134:711–715, 1980

    • Search Google Scholar
    • Export Citation
  • 9.

    Davis KR, , New PFJ, & Ojemann RG, et al: Computed tomographic evaluation of hemorrhage secondary to intracranial aneurysm. AJR 127:143153, 1976 Davis KR, New PFJ, Ojemann RG, et al: Computed tomographic evaluation of hemorrhage secondary to intracranial aneurysm. AJR 127:143–153, 1976

    • Search Google Scholar
    • Export Citation
  • 10.

    Doczi T, , Ambrose J, & O'Laoire S: Significance of contrast enhancement in cranial computerized tomography after subarachnoid hemorrhage. J Neurosurg 60:335342, 1984 Doczi T, Ambrose J, O'Laoire S: Significance of contrast enhancement in cranial computerized tomography after subarachnoid hemorrhage. J Neurosurg 60:335–342, 1984

    • Search Google Scholar
    • Export Citation
  • 11.

    Fisher CM, , Kistler JP, & Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:19, 1980 Fisher CM, Kistler JP, Davis JM: Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9, 1980

    • Search Google Scholar
    • Export Citation
  • 12.

    Gurusinghe NT, & Richardson AE: The value of computerized tomography in aneurysmal subarachnoid hemorrhage. The concept of the CT score. J Neurosurg 60:763770, 1984 Gurusinghe NT, Richardson AE: The value of computerized tomography in aneurysmal subarachnoid hemorrhage. The concept of the CT score. J Neurosurg 60:763–770, 1984

    • Search Google Scholar
    • Export Citation
  • 13.

    Hunt WE: Grading of risk in intracranial aneurysms, in Sano K, , Ishii S, & Le Vay D (eds): Recent Progress in Neurological Surgery; Proceedings of the Symposia of the Fifth International Congress of Neurological Surgery. Amsterdam: Excerpta Medica, 1974, pp 169175 Hunt WE: Grading of risk in intracranial aneurysms, in Sano K, Ishii S, Le Vay D (eds): Recent Progress in Neurological Surgery; Proceedings of the Symposia of the Fifth International Congress of Neurological Surgery. Amsterdam: Excerpta Medica, 1974, pp 169–175

    • Search Google Scholar
    • Export Citation
  • 14.

    Hunt WE, & Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:1420, 1968 Hunt WE, Hess RM: Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20, 1968

    • Search Google Scholar
    • Export Citation
  • 15.

    Isu T, , Uemura K, , Goto K, et al: [Computed tomographic findings in intracranial hemorrhage due to ruptured intracranial aneurysm.] Rinsho Hoshasen 23:701709, 1978 (Jpn)Isu T, Uemura K, Goto K, et al: [Computed tomographic findings in intracranial hemorrhage due to ruptured intracranial aneurysm.] Rinsho Hoshasen 23:701–709, 1978 (Jpn)

    • Search Google Scholar
    • Export Citation
  • 16.

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480484, 1975 Jennett B, Bond M: Assessment of outcome after severe brain damage. A practical scale. Lancet 1:480–484, 1975

    • Search Google Scholar
    • Export Citation
  • 17.

    Kassell NF, & Drake CG: Timing of aneurysm surgery. Neurosurgery 10:514519, 1982 Kassell NF, Drake CG: Timing of aneurysm surgery. Neurosurgery 10:514–519, 1982

    • Search Google Scholar
    • Export Citation
  • 18.

    Kassell NF, & Torner JC: The International Cooperative Study on Timing of Aneurysm Surgery — an update. Stroke 15:566570, 1984 Kassell NF, Torner JC: The International Cooperative Study on Timing of Aneurysm Surgery — an update. Stroke 15:566–570, 1984

    • Search Google Scholar
    • Export Citation
  • 19.

    Kistler JP, , Crowell RM, & Davis KR, et al: The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology 33:424436, 1983 Kistler JP, Crowell RM, Davis KR, et al: The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study. Neurology 33:424–436, 1983

    • Search Google Scholar
    • Export Citation
  • 20.

    Liliequist B, , Lindqvist M, & Valdimarsson E: Computed tomography and subarachnoid hemorrhage. Neuroradiology 14:2126, 1977 Liliequist B, Lindqvist M, Valdimarsson E: Computed tomography and subarachnoid hemorrhage. Neuroradiology 14:21–26, 1977

    • Search Google Scholar
    • Export Citation
  • 21.

    Lindsay KW, , Teasdale GM, & Knill-Jones RP: Observer variability in assessing the clinical features of subarachnoid hemorrhage. J Neurosurg 58:5762, 1983 Lindsay KW, Teasdale GM, Knill-Jones RP: Observer variability in assessing the clinical features of subarachnoid hemorrhage. J Neurosurg 58:57–62, 1983

    • Search Google Scholar
    • Export Citation
  • 22.

    Lindsay KW, , Teasdale G, & Knill-Jones RP, et al: Observer variability in grading patients with subarachnoid hemorrhage. J Neurosurg 56:628633, 1982 Lindsay KW, Teasdale G, Knill-Jones RP, et al: Observer variability in grading patients with subarachnoid hemorrhage. J Neurosurg 56:628–633, 1982

    • Search Google Scholar
    • Export Citation
  • 23.

    Ljunggren B, , Säveland H, & Brandt L, et al: Aneurysmal subarachnoid hemorrhage. Total annual outcome in a 1.46 million population. Surg Neurol 22:435438, 1984 Ljunggren B, Säveland H, Brandt L, et al: Aneurysmal subarachnoid hemorrhage. Total annual outcome in a 1.46 million population. Surg Neurol 22:435–438, 1984

    • Search Google Scholar
    • Export Citation
  • 24.

    Ljunggren B, , Sonesson B, & Säveland H, et al: Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation. J Neurosurg 62:673679, 1985 Ljunggren B, Sonesson B, Säveland H, et al: Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation. J Neurosurg 62:673–679, 1985

    • Search Google Scholar
    • Export Citation
  • 25.

    Mizukami M, , Takemae T, & Tazawa T, et al: Value of computed tomography in the prediction of cerebral vasospasm after aneurysm rupture. Neurosurgery 7:583586, 1980 Mizukami M, Takemae T, Tazawa T, et al: Value of computed tomography in the prediction of cerebral vasospasm after aneurysm rupture. Neurosurgery 7:583–586, 1980

    • Search Google Scholar
    • Export Citation
  • 26.

    Mohsen F, , Pomonis S, & Illingworth R: Prediction of delayed cerebral ischaemia after subarachnoid haemorrhage by computed tomography. J Neurol Neurosurg Psychiatry 47:11971202, 1984 Mohsen F, Pomonis S, Illingworth R: Prediction of delayed cerebral ischaemia after subarachnoid haemorrhage by computed tomography. J Neurol Neurosurg Psychiatry 47:1197–1202, 1984

    • Search Google Scholar
    • Export Citation
  • 27.

    Nishioka H: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section VII. Part I. Evaluation of conservative management of ruptured intracranial aneurysms. J Neurosurg 25:574592, 1966 Nishioka H: Report on the Cooperative Study of Intracranial Aneurysms and Subarachnoid Hemorrhage. Section VII. Part I. Evaluation of conservative management of ruptured intracranial aneurysms. J Neurosurg 25:574–592, 1966

    • Search Google Scholar
    • Export Citation
  • 28.

    Pasqualin A, , Rosta L, & Da Pian R, et al: Role of computed tomography in the management of vasospasm after subarachnoid hemorrhage. Neurosurgery 15:344353, 1984 Pasqualin A, Rosta L, Da Pian R, et al: Role of computed tomography in the management of vasospasm after subarachnoid hemorrhage. Neurosurgery 15:344–353, 1984

    • Search Google Scholar
    • Export Citation
  • 29.

    Ropper AH, & Zervas NT: Outcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality, and functional status in 112 consecutive good-risk patients. J Neurosurg 60:909915, 1984 Ropper AH, Zervas NT: Outcome 1 year after SAH from cerebral aneurysm. Management morbidity, mortality, and functional status in 112 consecutive good-risk patients. J Neurosurg 60:909–915, 1984

    • Search Google Scholar
    • Export Citation
  • 30.

    Saito I, , Shigeno T, & Aritake K, et al: Vasospasm assessed by angiography and computerized tomography. J Neurosurg 51:466475, 1979 Saito I, Shigeno T, Aritake K, et al: Vasospasm assessed by angiography and computerized tomography. J Neurosurg 51:466–475, 1979

    • Search Google Scholar
    • Export Citation
  • 31.

    Sano H, , Kanno T, & Shinomiya Y, et al: Prospection of chronic vasospasm by CT findings. Acta Neurochir 63:2330, 1982 Sano H, Kanno T, Shinomiya Y, et al: Prospection of chronic vasospasm by CT findings. Acta Neurochir 63:23–30, 1982

    • Search Google Scholar
    • Export Citation
  • 32.

    Sano K, & Tamura A: A proposal for grading of subarachnoid haemorrhage due to aneurysm rupture, in Auer LM (ed): Timing of Aneurysm Surgery. New York: Walter de Gruyter, 1985, pp 37 Sano K, Tamura A: A proposal for grading of subarachnoid haemorrhage due to aneurysm rupture, in Auer LM (ed): Timing of Aneurysm Surgery. New York: Walter de Gruyter, 1985, pp 3–7

    • Search Google Scholar
    • Export Citation
  • 33.

    Scotti G, , Ethier R, & Melançon D, et al: Computed tomography in the evaluation of intracranial aneurysms and subarachnoid hemorrhage. Radiology 123:8590, 1977 Scotti G, Ethier R, Melançon D, et al: Computed tomography in the evaluation of intracranial aneurysms and subarachnoid hemorrhage. Radiology 123:85–90, 1977

    • Search Google Scholar
    • Export Citation
  • 34.

    Suzuki J, , Komatsu S, & Sato T, et al: Correlation between CT findings and subsequent development of cerebral infarction due to vasospasm in subarachnoid haemorrhage. Acta Neurochir 55:6370, 1980 Suzuki J, Komatsu S, Sato T, et al: Correlation between CT findings and subsequent development of cerebral infarction due to vasospasm in subarachnoid haemorrhage. Acta Neurochir 55:63–70, 1980

    • Search Google Scholar
    • Export Citation
  • 35.

    Suzuki J, , Yoshimoto T, & Kayama T: Surgical treatment of middle cerebral artery aneurysms. J Neurosurg 61:1723, 1984 Suzuki J, Yoshimoto T, Kayama T: Surgical treatment of middle cerebral artery aneurysms. J Neurosurg 61:17–23, 1984

    • Search Google Scholar
    • Export Citation
  • 36.

    Tabaddor K, , Mattis S, & Zazula T: Cognitive sequelae and recovery course after moderate and severe head injury. Neurosurgery 14:701708, 1984 Tabaddor K, Mattis S, Zazula T: Cognitive sequelae and recovery course after moderate and severe head injury. Neurosurgery 14:701–708, 1984

    • Search Google Scholar
    • Export Citation
  • 37.

    Tazawa T, , Mizukami M, & Kawase T, et al: Relationship between contrast enhancement on computed tomography and cerebral vasospasm in patients with subarachnoid hemorrhage. Neurosurgery 12:643648, 1983 Tazawa T, Mizukami M, Kawase T, et al: Relationship between contrast enhancement on computed tomography and cerebral vasospasm in patients with subarachnoid hemorrhage. Neurosurgery 12:643–648, 1983

    • Search Google Scholar
    • Export Citation
  • 38.

    Teasdale G, , Knill-Jones RP, & Lindsay KW: Response to Hunt WE: Clinical assessment of SAH. J Neurosurg 59:550551, 1983 (Letter) Teasdale G, Knill-Jones RP, Lindsay KW: Response to Hunt WE: Clinical assessment of SAH. J Neurosurg 59:550–551, 1983 (Letter)

    • Search Google Scholar
    • Export Citation
  • 39.

    Teasdale GM, , Lindsay KW, & Allardyce G, et al: Standardized clinical grading of patients with subarachnoid haemorrhage: uniform international system?, in Auer LM (ed): Timing of Aneurysm Surgery. New York: Walter de Gruyter, 1985, pp 914 Teasdale GM, Lindsay KW, Allardyce G, et al: Standardized clinical grading of patients with subarachnoid haemorrhage: uniform international system?, in Auer LM (ed): Timing of Aneurysm Surgery. New York: Walter de Gruyter, 1985, pp 9–14

    • Search Google Scholar
    • Export Citation
  • 40.

    Teissier du Cros J, & Lhermitte F: Neuropsychological analysis of ruptured saccular aneurysms of the anterior communicating artery after radical therapy (32 cases). Surg Neurol 22:353359, 1984 Teissier du Cros J, Lhermitte F: Neuropsychological analysis of ruptured saccular aneurysms of the anterior communicating artery after radical therapy (32 cases). Surg Neurol 22:353–359, 1984

    • Search Google Scholar
    • Export Citation
  • 41.

    Weisberg LA: Computed tomography in aneurysmal subarachnoid hemorrhage. Neurology 29:802808, 1979 Weisberg LA: Computed tomography in aneurysmal subarachnoid hemorrhage. Neurology 29:802–808, 1979

    • Search Google Scholar
    • Export Citation
  • 42.

    Yamamoto I, , Hara M, & Ogura K, et al: Early operation for ruptured intracranial aneurysms: comparative study with computed tomography. Neurosurgery 12:169174, 1983 Yamamoto I, Hara M, Ogura K, et al: Early operation for ruptured intracranial aneurysms: comparative study with computed tomography. Neurosurgery 12:169–174, 1983

    • Search Google Scholar
    • Export Citation
  • 43.

    Yasui N, , Kawamura S, & Ohta H, et al: Prognostic factors of ruptured intracranial aneurysms — new clinical grading, in Auer LM (ed): Timing of Aneurysm Surgery. New York: Walter de Gruyter, 1985, pp 1520 Yasui N, Kawamura S, Ohta H, et al: Prognostic factors of ruptured intracranial aneurysms — new clinical grading, in Auer LM (ed): Timing of Aneurysm Surgery. New York: Walter de Gruyter, 1985, pp 15–20

    • Search Google Scholar
    • Export Citation

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