1986 Volume 53 Issue 4 Pages 366-374
The clinical outcome of 53 patients with severe subarachnoid hemorrhage (SAH) [grade 4 or 5 according to Hunt and Kosnik] was analyzed by computerized tomographic (CT) findings, auditory brainstem response (ABR) and intracranial pressure (ICP) monitoring. All the patients were admitted to our hospital within 3 hours after the first aneurysmal rupture. Fifteen patients were dead or nearly dead on admission. Seventeen patients were subjected to immediate direct surgical treatment of the aneurysm. The overall mortality was 83% (44 cases). In all cases, SAH visualized on CT were located in the basal cisterns surrounding the brainstem. ABR was recorded in 39 cases.
The ABR patterns on admission were classified into 4 groups : normal (Group I ), slight prolongation of interwave latency (Group II), severe prolongation of interwave latency (Group III) and disappearance of second to fifth waves or no response (Group N). Patients in Group IV were dead. Three patients whose ABR returned to normal survived, suggesting that they had reversible brainstem failure. ICP was monitored in 18 cases. Patients whose ICP did not increase during the monitoring survived.
The major mechanism leading to death or deterioration after acute SAH appears to result from brainstem failure arising from subarachnoid hematoma in the basal cisterns surrounding the brainstem and by acute brain swelling following secondary cerebral ischemia due, to cardiac and respiratory failure.
