1985 Volume 25 Issue 6 Pages 448-454
Clinical gradings for the cerebral aneurysm, advocated by Botterell, Nishioka or Hunt have been commonly used for evaluating the patient condition and the indication of the aneurysm surgery. In this study, new clinical grading classifying the patient condition according to their level of consciousness, herniation sign and also the accompanying conditions, which are evaluated by computerized tomography (CT) and angiography were reported. These include massive subarachnoid hemorrhage (SAH) in CT, intracerebral hematoma (ICH) with mass signs, such as midline shift and deformity of the ventricle, and vasospasm (VS) detected in angiography. Clinical results of the treatment for aneurysm cases in the acute stage are also reported.
Two hundred ninety-one cases of anterior communicating, internal carotid and middle cerebral artery aneurysms which were admitted within 7 days after the last attack were studied. Of these 260 cases were operated on. The mortality of all cases was 16.2% and the morbidity was 13.7%. Number of cases having accompanying conditions were increasing as the grading. Most of the cases in grade 2 and 3 without accompanying conditions recovered to a good condition, except for cases with a rebleeding attack after the admission. The cause of the poor outcome in grade 2 and 3 with SAH and VS was cerebral ischemia following VS. Incidences with the two or three accompanying conditions increased in cases with grade 4 or more. Twenty out of 28 severe cases in grade 5b and 6 showed massive ICH on admission. Good outcome in cases with grade 4 or more were obtained in cases without VS.
The accompanying conditions showed the cause of severity in a high grade case and helped to estimate the secondary pathophysiological state and to take preventive methods against it in a low grade case. Acute hydrocephalus was not rated as an accompanying condition, because no correlation was found between clinical severity and outcome. Clinical grading, based on level of consciousness, herniation signs and accompanying conditions were well correlated with the outcome and showed the operative timing and indication.
