New clinical grading in ruptured cerebral aneurysm
Sato, J.; Masuzawa, H.; Shiraishi, K.; Kanazawa, I.; Kamitani, H.
No Shinkei Geka. Neurological Surgery 14(10): 1183-1187
1986
ISSN/ISBN: 0301-2603 PMID: 3785560 Document Number: 279019
A new clinical grading of subarachnoid hemorrhage (SAH) due to ruptured aneurysm, classified by the presence or absence of vomiting, and by the duration of initial unconsciousness at the time of bleeding, is proposed. Grade I: headache without vomiting, Grade II: headache, vomiting and/or loss of consciousness lasting less than one hour, Grade III: loss of consciouness for over one hour. Grade IV: permanent unconsciousness or cerebral herniation signs. Based on the clinical records, 142 cases of ruptured cerebral aneurysms directly operated on in phases varying from peracute phase (within 72 hours) to delayed phase (22 days or over) were retrospectively analyzed. They included 99 cases which were operated on under microscope. The Hunt and Hess grading was applied just before surgery. Outcome at the 6 month to 1 year follow-up was rated as good, fair, poor and dead. Correlations between the severity and the outcome were calculated using the chi-square test and the levels of significance were compared with those between the recent Hunt and Hess grading and the outcome. In the total of 142 cases, correlation between the clinical severity and the outcome was significant (P < 0.0005), whereas correlation between the Hunt and Hess grading and the outcome was not significant. In the analysis of cases classified by the operative timing, the clinical severity showed good correlation in the presence (within 72 hours after SAH) (P < 0.05) alone, while Hunt and Hess grading showed correlation in delayed phase alone. Neither of the gradings was significant in the acute phase or subacute phase. The similar tendencies were noted in the analysis of 99 cases. In conclusion, our clinical severity, based on headache, vomiting and the duration of the initial unconsciousness at the time of bleeding were more correlated with the outcome of the patients than the Hunt and Hess grading except in the delayed phase.