| Subarachnoid hemorrhage on computed tomography scanning and the development of cerebral vasospasm: the Fisher grade revisited. | |
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MedLine Citation:
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PMID: 15734507 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The Fisher grade (FG) is widely used to predict cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). We revisited the grading scale to determine its validity in the era of modern management. METHODS: We retrospectively reviewed the records of 134 patients with SAH. The amount and distribution of subarachnoid blood on admission computed tomography (CT) scan was quantified according to the FG and compared with development of symptomatic vasospasm. RESULTS: We reviewed 134 patients (median age, 54) who presented with aneurysmal SAH. Six (5%) were FG 1, 34 (25%) were FG 2, 25 (19%) were FG 3, and 69 (51%) were FG 4. Symptomatic vasospasm developed in no (0%) FG 1, 8 (24%) FG 2, 7 (28 %) FG 3, and 13 (19%) FG 4 patients (28 of 134 total patients; 21%). Development of symptomatic vasospasm was not associated with admission FG, Hunt and Hess grade, age, sex, or location of blood on presenting CT scan. Elevated transcranial Doppler blood flow velocity was associated with blood in the basal cisterns (P = .0047), lateral ventricles (P = .026), or blood in any ventricle (P = .04). Postoperative angiograms were obtained in 57 patients; moderate to severe vasospasm was observed in 5 (15%) FG 2, 6 (24%) FG 3, and 14 (20%) FG 4 patients. Twenty patients (71%) with symptomatic vasospasm had moderate or severe angiographic vasospasm. Angiographic vasospasm was associated with intraventricular blood (P = .054) but not with FG. CONCLUSIONS: Symptomatic vasospasm occurred in 21% of cases. The FG correlated with symptomatic vasospasm in only half the patients. A new predictive CT grading scale for vasospasm may be necessary. |
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Authors:
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Michael L Smith; John M Abrahams; Sid Chandela; Michelle J Smith; Robert W Hurst; Peter D Le Roux |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Surgical neurology Volume: 63 ISSN: 0090-3019 ISO Abbreviation: Surg Neurol Publication Date: 2005 Mar |
Date Detail:
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Created Date: 2005-02-28 Completed Date: 2005-04-12 Revised Date: 2006-12-26 |
Medline Journal Info:
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Nlm Unique ID: 0367070 Medline TA: Surg Neurol Country: United States |
Other Details:
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Languages: eng Pagination: 229-34; discussion 234-5 Citation Subset: IM |
Affiliation:
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Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA 19146, USA. smithmic@uphs.upenn.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Age Factors Aged Aged, 80 and over Cerebral Angiography Cerebral Arteries / physiopathology, radiography Cerebrovascular Circulation / physiology Disease Progression Female Humans Intracranial Aneurysm / complications, surgery Male Middle Aged Predictive Value of Tests Reproducibility of Results Retrospective Studies Severity of Illness Index* Sex Factors Subarachnoid Hemorrhage / complications, radiography*, surgery Subarachnoid Space / radiography, surgery Tomography, X-Ray Computed / standards* Ultrasonography, Doppler, Transcranial / standards Vasospasm, Intracranial / etiology, radiography* |
| Comments/Corrections | |
Comment In:
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Surg Neurol. 2006 Mar;65(3):316-7; author reply 317
[PMID:
16488267
]
Surg Neurol. 2006 Nov;66(5):551-2; author reply 552 [PMID: 17084213 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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