Factors influencing the outcome of aneurysm rupture in poor grade patients: a prospective series.
When is the outlook hopeless after rupture of an intracranial aneurysm? Some data bearing on the answer to this important question were obtained in a prospective, multicenter trial of 184 poor grade patients in a study of the calcium antagonist nimodipine. Entry was within 3 days of subarachnoid hemorrhage (SAH). The admission work-up included angiography of the anterior and posterior circulations and computed tomographic (CT) scans. The angiograms were repeated as close to Day 8 post-SAH as possible, and the CT scans were repeated at 3 months at the time of follow-up neurological assessment. Radiological assessment was performed independently of knowledge of drug treatment or patient outcome. A discriminant function analysis indicated that the relative importance of factors prognostic for outcome was, in order of importance: whether the patient was treated surgically, neurological grade on admission, age, initial systolic blood pressure, and aneurysm size. The discriminant function analysis correctly classified 80% of our cases. A constellation of poor prognostic features will aid the neurosurgeon in treating a patient conservatively and appropriately advising relatives. The ultimate decision on how to treat a given patient continues to depend partly on clinical judgement, which remains intuitive and subject to influences not studied here.
Disney
L
L
Department of Surgery, University of Alberta, Edmonton.
Weir
B
B
Grace
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D006973:Hypertension / Q000150:complications; D002532:Intracranial Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D002546:Ischemic Attack, Transient / Q000209:etiology; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed