Risk Profile of Patients with Poor-Grade Aneurysmal Subarachnoid Hemorrhage Using Early Perfusion Computed Tomography

• Published in: World neurosurgery 2012-11, Vol.78 (5), p.455-461
• Main Authors: Tsuang, Fon-Yih, Chen, Jo-Yu, Lee, Chung-Wei, Li, Chien-Hsun, Lee, Jing-Er, Lai, Dar-Ming, Hu, Fu-Chang, Tu, Yong-Kwang, Hsieh, Sung-Tsang, Wang, Kuo-Chuan
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aneurysm; Disability Evaluation; Early Diagnosis; Female; Follow-Up Studies; Glasgow Coma Scale; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Neurosurgery; Perfusion computed tomography; Persistent Vegetative State - diagnostic imaging; Persistent Vegetative State - mortality; Prognosis; Recovery of Function; Reproducibility of Results; Retrospective Studies; Risk Factors; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - mortality; Tomography, X-Ray Computed - methods; Tomography, X-Ray Computed - standards; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2011.12.004

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.