Abstract
The optimum management for patients with severe aneurysmal subarachnoid hemorrhage (SAH) remains controversial. Previous studies have used different clinical grading systems or different timings for grading when using the same classification. Therefore, the present study tried to identify the prognostic factors and indications for active treatment. Patient management and outcome were retrospectively reviewed in 146 cases of severe SAH classified into Hunt and Kosnik grades IV and V. The general condition of the patient was not considered at grading. There were 131 patients in grade IV (JCS 30-200,GCS 4-10) and 15 patients in grade V (JCS 300,GCS 3). This study found that surgical treatment in the early stage, within 24 hours after onset, is essential for patients in grade IV aged less than 80 years leading a normal life before onset without severe systemic disease. However, there is no indication for surgery in patients with grade V SAH.
