[New clinical grading in ruptured cerebral aneurysm].
A new clinical grading of subarachnoid hemorrhage (SAH) due to ruptured aneurysm, classified by the presence or absence of vomiting, and by the duration of initial unconciousness at the time of bleeding, is proposed. Grade I: headache without vomiting, Grade II: headache, vomiting, and/or loss of consciousness lasting less than one hour, Grade III: loss of consciouness for over one hour. Grade IV: permanent unconsciousness or cerebral herniation signs. Based on the clinical records, 142 cases of ruptured cerebral aneurysms directly operated on in phases varying from peracute phase (within 72 hours) to delayed phase (22 days or over) were retrospectively analyzed. They included 99 cases which were operated on under microscope. The Hunt & Hess grading was applied just before surgery. Outcome at the 6 month to 1 year follow-up was rated as good, fair, poor and dead. Correlations between the severity and the outcome were calculated using the chi-square test and the levels of significance were compared with those between the recent Hunt and Hess grading and the outcome. In the total of 142 cases, correlation between the clinical severity and the outcome was significant (P less than 0.0005), whereas correlation between the Hunt & Hess grading and the outcome was not significant. In the analysis of cases classified by the operative timing, the clinical severity showed good correlation in the peracute (within 72 hours after SAH) (P less than 0.05) alone, while Hunt & Hess grading showed correlation in delayed phase alone. Neither of the gradings was significant in the acute phase or subacute phase.(ABSTRACT TRUNCATED AT 250 WORDS)
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D013345:Subarachnoid Hemorrhage / Q000145:classification / Q000175:diagnosis* / Q000601:surgery