Document Detail

Outcome in poor grade subarachnoid hemorrhage patients treated with acute endovascular coiling of aneurysms and aggressive intensive care.
MedLine Citation:
PMID:  20464529     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Patients with poor grade (World Federation of Neurosurgeons (WFNS) Grades 4 and 5) subarachnoid hemorrhage (SAH) were historically considered to have a poor neurological outcome and therefore not traditionally offered aggressive treatment. In recent years there has been increasing evidence that early aggressive treatment of this patient group can result in a good outcome. Aim of this study is to identify the outcome of patients with WFNS Grade-4 and -5 SAH treated acutely with endovascular detachable coil embolization (DCE) and aggressive neurocritical care within our institution.
METHODS: We retrospectively reviewed the records of patients with SAH WFNS Grades 4 and 5 treated with DCE within 7 days of admission between 1st January 2004 and 1st January 2008. Data collected included age, sex, grade SAH, position/number of Aneurysms, coiling complications, time spent on the neurosurgical critical care unit (NCCU), and 6-month outcome assessed by Glasgow outcome scale (GOS). GOS was dichotomized into good outcome (good recovery/moderate disability) and poor outcome (severe disability, vegetative, dead).
RESULTS: A total of 193 acute SAH patients were admitted and treated within this time period, of these, 47 patients were classified as poor grade and included: 70% were female and 30% were male. The mean age was 56 years (33-88 years range). A total of 56 aneurysms were noted at angiography, 52 aneurysms were coiled. Complications of SAH Vasospasm was noted in 18 patients (38%), cerebral infarction in 13 patients (28%), seizures in 7 patients (15%), hydrocephalus in 25 patients (53%). Complications of DCE occurred in 2 patients (4% of total) these were an aneurysmal rupture and a peri-procedure thrombosis. Incomplete coiling occurred in another 5 patients (10.6% of total) due to technical difficulties. The median length of stay on the NCCU was 12 days (1-52 days range). Of the 47 poor grade patients coiled, 25 (53%) had a good outcome (good recovery/moderate disability) and 22 (47%) had a poor outcome (severe disability, vegetative, dead) by the time of the 6-month follow-up.
CONCLUSION: Potentially, more than half the patients with WFNS Grade-4 and -5 SAH who are treated aggressively with coil embolization in association with supportive neurocritical care can achieve a good quality neurological outcome. However, it should be anticipated that these patients will spend a significant period of time in neurocritical care.
Christopher J Taylor; Fergus Robertson; David Brealey; Frankie O'shea; Tina Stephen; Stefan Brew; Joan P Grieve; Martin Smith; Ian Appleby
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurocritical care     Volume:  14     ISSN:  1556-0961     ISO Abbreviation:  Neurocrit Care     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-04     Completed Date:  2011-09-08     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  341-7     Citation Subset:  IM    
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MeSH Terms
Acute Disease
Aged, 80 and over
Aneurysm, Ruptured / classification,  mortality,  therapy
Disability Evaluation
Embolization, Therapeutic / methods*
Glasgow Coma Scale*
Glasgow Outcome Scale
Hospital Mortality
Intensive Care / methods*
Middle Aged
Neurologic Examination
Retrospective Studies
Subarachnoid Hemorrhage / classification,  mortality,  therapy*
Grant Support
G0701458//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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