Abstract
A retrospective analysis has been conducted of the overall management of 262 subarachnoid hemorrhage patients with a WFNS grading of IV and V. The patients were divided into two groups according to their hospital admission: 143 patients who were the former group treated from 1981 through 1986, 119 patients treated from 1987 to 1993. Of the 143 cases in the former group and the 119 cases in the latter group, 87% were admitted to hospital within 24 hours and 93% within 72 hours after their hemorrhage. These cases amounted to one-third of all cases of an aneurysmal subarachnoid hemorrhage during the two periods. The outcome of the conservatively treated cases was poor both in the grade IV and V patients: one case was left with a severe disability, two have survived in a vegetative state, and the others died. In the grade IV, patients of the latter period, the overall outcome was better. Also, cases that had a poor outcome caused by a vasospasm or an operative complication due to other than the severity of the attack were fewer among patients treated during the latter period. The grade IV cases were divide into two subgroups, based on the Glasgow Coma Scale (GCS) GCS 11 and 12 cases with a good outcome and GCS 7 to 10 cases with a poor outcome. For grade V patients, the outcome was poorer than for the grade IV patients, and these outcomes were about the same between the two treatment periods. Most of the cases with a poor outcome were due to the severity of the hemorrhage. Further, the outcomes were poor for most of the cases who underwent surgery more than 8 hours after the attack and for all cases with a CT score greater than 10. Based on these findings, it thus has been concluded that the outcomes of the grade IV patients can be improved due to the progress that has been made in operative procedures and in treating vasospasms. However, no improvement in the outcomes of grade V patients can be expected because of the severe brain damage that occurs due to hemorrhage. Any predicting factor for favorable outcome could not be found in grade V patients.
