原 著
院外心停止症例を含めたGCS 3-4重症くも膜下出血症例の特徴とその予後
キーワード:
poor grade,
subarachnoid hemorrhage,
out-of-hospital cardiac arrest,
prognosis,
cerebral aneurysm
2019 年 47 巻 3 号 p. 174-178
詳細
2019 年 47 巻 3 号 p. 174-178
Objective: The prognosis of patients with poor-grade subarachnoid hemorrhage (SAH), especially those with out-of-hospital cardiac arrest (OHCA), is extremely poor. The aim of this study was to assess the prognostic factors and characteristics of patients with SAH with Glasgow Coma Scale (GCS) scores of 3 or 4, including patients with OHCA.
Materials: Forty-two patients with GCS scores of 3 or 4, including 27 with OHCA, were evaluated. They were classified into a favorable outcome group (modified Rankin Scale [mRS] score of 0-2) and an unfavorable outcome group (mRS score of 3-6). The following factors were analyzed: OHCA, rebleeding, brain herniation, location and size of aneurysm, hydrocephalus, and surgical treatment.
Results: Nine patients (21%) underwent a surgical treatment for aneurysms. Five patients (12%) had a favorable outcome at 12 months. Surgical treatment was a significant favorable prognostic factor (p < 0.0001). OHCA (p < 0.005) and brain herniation (p < 0.01) were significant poor prognostic factors. In 24 cases (57%), causative aneurysms could be analyzed, including 18 saccular aneurysms and 6 dissecting aneurysms. Saccular aneurysms were located in the anterior communicating artery in 7 patients (39%) and in the posterior circulation in another 7 patients (39%). All dissecting aneurysms were located at the intradural vertebral artery. Half of the saccular aneurysms were <7 mm in size.
Conclusions: Although patients with OHCA and/or brain herniation inevitably results in poor prognosis, surgical treatment is recommended even for patients with SAH whose GCS score was 3 or 4, when their systemic condition allows.
