title: Predictors of outcome in World Federation of Neurologic Surgeons grade V aneurysmal subarachnoid hemorrhage patients.
abstract: BACKGROUND
  Only a small percentage of World Federation of Neurologic Surgeons grade V aneurysmal subarachnoid hemorrhage patients have a favorable outcome. The influence of clinical parameters on outcome was assessed.
  
  
  METHODS
  Retrospective evaluation of consecutive patients admitted from 2000-2007 with grade V subarachnoid hemorrhage at two institutions by evaluating, over time, the motor value of the Glasgow Coma Scale, effects of external ventricular drainage and rebleeding on outcome. Six-month outcome was assessed with the extended Glasgow Outcome Scale; favorable outcome was defined as good recovery or moderately disabled.
  
  
  RESULTS
  Of 126 patients, 28 had absent brainstem reflexes, without improvement after external ventricular drainage. Rebleeding occurred in 26 patients, resulting in treatment withdrawal in 14. Only one patient had a favorable outcome after rebleeding. Of the 84 remaining patients, 61 improved at day 2 after subarachnoid hemorrhage to Glasgow Coma Scale motor value ≥4; 24 of these (39%) had a favorable outcome. All 23 patients with a Glasgow Coma Scale motor value ≤3 had an unfavorable outcome or died. Patients younger than 65 yrs of age had a better outcome (p < .03). Hydrocephalus was present in 71 of 84 patients. Favorable outcome was similar for patients with a positive external ventricular drainage response (8 of 28) as compared to no response to external ventricular drainage (12 of 43).
  
  
  CONCLUSIONS
  The high rebleeding rate and subsequent poor outcome in World Federation of Neurologic Surgeons grade V patients warrants early treatment to secure the ruptured aneurysm. Favorable outcome was seen in 39% of patients with a Glasgow Coma Scale motor value ≥4 at day 2. In this study, patients with Glasgow Coma Scale motor value ≤3 at day 2 all had a very poor prognosis.
authors.affiliation: Department of Radiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. R.vdberg@amc.uva.nl
authors.forename: René
authors.initials: R
authors.lastname: van den Berg
authors.forename: Mahrouz
authors.initials: M
authors.lastname: Foumani
authors.forename: Rosalie D
authors.initials: RD
authors.lastname: Schröder
authors.forename: Saskia M
authors.initials: SM
authors.lastname: Peerdeman
authors.forename: Janneke
authors.initials: J
authors.lastname: Horn
authors.forename: Shandra
authors.initials: S
authors.lastname: Bipat
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
mesh_terms: D000367:Age Factors; D000368:Aged; D015600:Glasgow Coma Scale; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed