Poor-grade aneurysmal subarachnoid hemorrhage outcome

• Blood-Brain Barrier Disruption Predicts Poor Outcome in Subarachnoid Hemorrhage: A Dynamic Contrast-Enhanced MRI Study
• Analysis of short-term efficacy and rebleeding risk in aneurysmal subarachnoid hemorrhage patients undergoing vascular intervention
• Infection Associated with Global Cerebral Edema and Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage
• Aneurysmal subarachnoid hemorrhage in elderly patients: fluctuations in serum sodium levels were associated with poor neurological outcomes
• Clinical factors associated with delayed ischemic and non-ischemic adverse events in clazosentan therapy after aneurysmal subarachnoid hemorrhage: early insights from a multicenter prospective registry
• Validation of the SHELTER score after aneurysmal subarachnoid hemorrhage cohort: An observational retrospective study
• Lack of association between chronological age and fisher group and poor outcomes in older patients with severe-grade aneurysmal subarachnoid hemorrhage: a nationwide registry study in Japan
• Pentraxin 3 as a Prognostic Biomarker in Aneurysmal Subarachnoid Hemorrhage

Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is associated with poor neurological outcomes and high mortality. A major factor influencing morbidity and mortality is brain swelling in the acute phase ¹⁾.

see Poor-grade aneurysmal subarachnoid hemorrhage complications.

see also Aneurysmal subarachnoid hemorrhage outcome.

A study provides a reliable and valuable nomogram that can accurately predict the risk of poor prognosis in patients with poor-grade aSAH after microsurgical clipping. This tool is easy to use and can help physicians make appropriate clinical decisions to improve patient prognosis significantly ²⁾.

Age, loss of consciousness at onset, systolic blood pressure on admission, Hunt-Hess grade 4-5 on admission, epileptic seizures, modified Fisher grade 3-4, microsurgical clipping, size of the ruptured aneurysm, and cerebrospinal fluid replacement were independent risk factors for aSAH outcomes ³⁾.

WFNS grade 5, signs of brain herniation, aneurysm size, and space-occupying hematoma ⁴⁾

Ultra-early vasospasm (UEV) and the presence of dissecting aneurysms are the strongest predictors of aneurysmal rebleeding. Their presence should be carefully evaluated in the acute management of poor-grade aSAH ⁵⁾.

There is a tendency for patients in poor clinical grades to have more vasospasm. The patients with the most vasospasm have significantly higher mortality than those with the least ⁶⁾.

There was a better outcome in patients with an HH score of 4 compared to an HH score of 5 and both groups benefited from surgical treatment, which resulted in a positive outcome in almost 50% of surgically treated patients ⁷⁾.

Patients with poor-grade subarachnoid hemorrhage (SAH) admitted to the intensive care unit (ICU) often require prolonged invasive mechanical ventilation due to prolonged time to obtain neurological recovery. Impairment of consciousness and airway protective mechanisms usually require tracheostomy during the ICU stay to facilitate weaning from sedation, promote neurological assessment, and reduce mechanical ventilation (MV) duration and associated complications ⁸⁾.

A lower mean temperature was univariately associated with a worse primary brain injury, with higher Fisher grade and higher MD glycerol concentration, as well as a worse neurological recovery at 1 year. There was otherwise no association between temperature and cerebral physiological variables in the early phase. There was a transition toward an increased burden of hyperthermia (temperature > 38 °C) in the vasospasm phase. This was associated with concurrent infections but not with neurological or radiological injury severity at admission. The elevated temperature was associated with higher MD pyruvate concentration, a lower rate of an MD pattern indicative of ischemia, and a higher rate of poor neurological recovery at 1 year. There was otherwise no association between temperature and cerebral physiological variables in the vasospasm phase. The associations between temperature and clinical outcome did not hold true in multiple logistic regression analyses.

Spontaneously low temperature in the early phase reflected a worse primary brain injury and indicated a worse outcome prognosis. Hyperthermia was common in the vasospasm phase and was more related to infections than primary injury severity but also with a more favorable energy metabolic pattern with better substrate supply, possibly related to hyperemia ⁹⁾.

Gastrointestinal bleeding was most frequently seen in those cases operated on between the third and seventh days after the last subarachnoid hemorrhage (8.9%) and was more common in cases with a relatively poor preoperative grade. The development of such bleeding in cases with a good preoperative grade was due to problems with the surgical operation in most cases, although the influence of vasospasm must not be ignored. The development of bleeding in cases with a poor preoperative grade is thought to be due primarily to vasospasm and transitory brain damage to the hypothalamus and the orbital portion of the anterior lobe due to a hematoma caused by aneurysm rupture. First, the location of gastrointestinal bleeding should be determined endoscopically and, if hemostasis is not achieved by coagulation, then the desirability of surgery should be considered early. Abdominal surgery may be performed ¹⁰⁾.