Abstract
Of patients in poor neurological condition after aneurysmal subarachnoid hemorrhage (SAH), we have often experienced cases in which grades have improved during a relatively short time after admission. In this paper, we examine changes of neurological grades on 80 patients who did not undergo urgent surgery in the acute stage of Hunt and Kosnik Grade IV and V (Grade IV 30 cases, V 50 cases).
Of the 80 patients, 27 (34%) showed grade improvement after admission. Fifteen (50%) were in Grade IV and 12 (24%) in Grade V. Of the 15 patients in Grade IV, 6 improved to Grade II and 9 to Grade III within 48 hours. Of the 12 patients in Grade V, 2 improved to Grade II, 3 to Grade III, and 7 to Grade IV within 24 hours. All patients were classified as Fisher Group 3 or 4 on the CT scan. There was no relationship between Fisher group and grade improvement. The rate of improvement in 51 patients of the younger group (69 years and under) was 45%, whereas that in 29 patients of the elderly group (70 years and over) was 14%. Of the 27 patients whose clinical course improved, acute surgery was performed in 25 patients and chronic surgery in 2 patients. As for the outcome at discharge, 9 (60%) in Grade IV and 6 (50%) Grade V made a good recovery or moderate disability.
We should closely observe changes in Grade IV ·V patients at least for 24 hours, so that we can perform surgery as soon as the patient's grade improves
