title: Risk profile of patients with poor-grade aneurysmal subarachnoid hemorrhage using early perfusion computed tomography.
abstract: OBJECTIVE
  To determine whether perfusion computed tomography (CT) is useful for identifying patients with poor-grade subarachnoid hemorrhage (SAH) with reversible etiologies and whether early obliteration in patients with poor-grade aneurysmal SAH leads to favorable outcomes.
  
  
  METHODS
  Patients with new-onset aneurysmal SAH in World Federation of Neurological Surgeons (WFNS) grade IV or V neurologic condition who had perfusion CT performed at admission were eligible for the study. The study retrospectively enrolled 38 patients seen between January 2007 and July 2009. The decision to perform an early obliteration was made by the family after a discussion with the neurosurgeons, neurointensivists, and interventional radiologists. The functional outcomes were correlated with the Glasgow Outcome Scale (GOS) at 6 months, and quantitative perfusion CT data were collected.
  
  
  RESULTS
  This study included 10 (26%) grade IV and 28 (74%) grade V patients. Favorable outcomes occurred in 19 (50%) patients, and 11 (29%) patients died. After a multivariate logistic regression analysis of the parameters, older age (odds ratio 1.104, P = 0.0317), bilateral prolonged mean transient time (MTT) at the thalami (odds ratio 4.155, P = 0.0362), and early obliteration (odds ratio 0.098, P = 0.003) were predictive of poor outcome.
  
  
  CONCLUSIONS
  Early bilateral prolonged MTT at the thalami and old age are associated with a poor outcome. Early obliteration benefits a significant portion of SAH patients.
authors.affiliation: Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan.
authors.forename: Fon-Yih
authors.initials: FY
authors.lastname: Tsuang
authors.forename: Jo-Yu
authors.initials: JY
authors.lastname: Chen
authors.forename: Chung-Wei
authors.initials: CW
authors.lastname: Lee
authors.forename: Chien-Hsun
authors.initials: CH
authors.lastname: Li
authors.forename: Jing-Er
authors.initials: JE
authors.lastname: Lee
authors.forename: Dar-Ming
authors.initials: DM
authors.lastname: Lai
authors.forename: Fu-Chang
authors.initials: FC
authors.lastname: Hu
authors.forename: Yong-Kwang
authors.initials: YK
authors.lastname: Tu
authors.forename: Sung-Tsang
authors.initials: ST
authors.lastname: Hsieh
authors.forename: Kuo-Chuan
authors.initials: KC
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018458:Persistent Vegetative State / Q000000981:diagnostic imaging* / Q000401:mortality*; D011379:Prognosis; D020127:Recovery of Function; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality*; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards; D055815:Young Adult