Factors affecting outcome in poor grade subarachnoid haemorrhage: An institutional study.
BACKGROUND
Poor grade subarachnoid hemorrhage (SAH) is usually associated with unfavorable outcomes and optimal management is deemed complicated. Most centres follow an expectant management strategy or a less aggressive approach till patients improve to good clinical grades. This approach has been associated with higher mortality and morbidity. However, not all patients with poor clinical condition fare badly. Identification and early aggressive management of this select group of patients may lead to favorable outcomes.


METHODS
Prospective non-randomized study.


METHODS
We prospectively analyzed 19 cases presented in WFNS grade 4 and 5 and factors affecting their outcome at a tertiary care centre in south India. This study was aimed at identifying those few poor grade patients who are probable candidates for a good outcome.


METHODS
All the variables were analyzed for possible correlations with the SPSS version 13 software. The Chi-square test with aP< 0.05 was taken as statistically significant.


RESULTS
Of 19 cases, 13 were operated and good outcome was seen in 53.8% of the patients who underwent surgery and aggressive management. All 7 patients who were managed conservatively died. 15.8% of the patients had low density changes (P= 0.625). Absence of such changes was associated with a good long term outcome (P= 0.004). 9 patients had intraventricular hemorrhage at presentation and 5 patients having hydrocephalus underwent extra-ventricular drainage. Statistically significant factors precluding good outcome were the presence of infarcts and thick SAH in the cisterns.


CONCLUSIONS
Poor grade (WFNS 4 and 5) SAH patients with or without ICH, IVH, if operated within 3 days can give rise to favorable outcome in around 50%. However, presence of patchy infarcts associated with thick subarachnoid blood (Fisher grade 3) precludes long term survival or meaningful recovery. Hence, aggressive management is unlikely to alter the natural history of such patients.
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India.
Sannepaneni
S
Kranthi
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India.
Barada P
BP
Sahu
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, India.
Purohit
P
Aniruddh
Aneurysm; poor grade; subarachnoid hemorrhage
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