gms | German Medical Science

Objective: In recent years, the prognosis of patients suffering from subarachnoid hemorrhage (SAH) has become the focus of many reports. Yet, most of these reports focus on patients afflicted by poor-grade SAH. To date, data on patients suffering from SAH according to Hunt & Hess grade (H&H) 1-3 is scarce. Therefore, we analyzed the outcome of these patients treated at our center between 2006 and 2011.

Method: Patients with aneurysmal SAH were entered into a prospectively collected database. We retrospectively selected the patients with H & H grade 1–3 and performed a multivariate analysis. Outcome was assessed by the modified Rankin Scale (mRS) six months after SAH and dichotomized into favorable (mRS 0-2) and poor (mRS 3-6).

Results: Within the selected period, 373 patients were included into this study (H&H 1: n=79, H&H 2: n=149, H&H 3: n=145). Of those, the ruptured aneurysm was clipped surgically in 30.8% and treated by endovascular coiling in 67.3%. Early hydrocephalus requiring external ventricular drainage was present in 54.7%. Treatment associated complications were documented in 15.5% of all treated patients with only one patient requiring surgical revision. Aneurysmal rebleeding occurred in 7.5% of patients before securing of the aneurysm. Some degree of narrowing of the arterial vessels related to cerebral vasospasm (CVS) was noted in 46.6% of patients and lead to delayed ischemic deficits as detected on imaging in 30.5%. Outcome was favorable in 73.7% and poor in 22.5%. In the multivariate analysis, CVS related ischemic deficits were the strongest predictor for poor outcome (OR 7.1, 95%CI 2.86–17.65, p<0.001) followed by angiographic CVS (OR 4.8, 95%CI 1.61–14.8, p=0.005), early hydrocephalus (OR 3.9, 95%CI 1.57–9.89, p=0.003), complications associated with aneurysm treatment (OR 2.8, 95%CI 1.06–7.49, p=0.038), aneurysm size (OR 1.19, 95%CI 1.04–1.36, p=0.013), and the patient’s age (OR 1.1, 95%CI 1.06–1.15, p<0.001). The patient’s sex, Fisher grade, presence of intracranial hematoma, rebleeding and Hunt & Hess grade on admission were not predictive for outcome. Neither was the method of aneurysm treatment.

Conclusions: In good-grade patients, the occurrence of delayed CVS and ischemic deficits are the most important risk factors for poor outcome, followed by the presence of early hydrocephalus and treatment-associated complications.