MANAGEMENT OF POOR GRADE PATIENTS AFTER SUBARACHNOID HEMORRHAGE - THEIMPORTANCE OF NEURORADIOLOGICAL FINDINGS ON CLINICAL OUTCOME

The prognosis for patients in poor neurological grade (WFNS grades IV and V) after subarachnoid haemorrhage (SAH) is grave. Previous reports of such patients have analysed outcome without defining either the ca use or the course of the depressed level of consciousness. We report a retrospective study of the outcome of 62 consecutive patients in poor grade after SAH analysed with respect to their clinical course and th e predominant computed tomographic feature. Neuroradiological findings were (1) intracranial haematoma, (2) hydrocephalus with or without in traventricular haemorrhage (IVH) and (3) SAH alone. Sixteen patients ( 25.8%) had a Glasgow Coma Score (GCS) less than or equal to 12 on admi ssion to hospital and subsequently deteriorated. The predominant compu ted tomographic feature of these patients was hydrocephalus/IVH. Twelv e patients (19.4%) had a GCS less than or equal to 12 on admission and subsequently improved without intervention; all had SAH on computed t omography (CT) on admission. Thirty-four patients (54.8%) had a GCS le ss than or equal to 12 on admission and did not improve or improved on ly after emergency surgical intervention. Haematoma (44%) and hydrocep halus/IVH (47%) were the predominant CT features in this group. The ov erall mortality in the 62 patients was 44%. Fifty-two per cent of pati ents achieved a good outcome or were moderately disabled. Patients har bouring an intracerebral haematoma had a significantly poorer prognosi s when compared with the other groups. Patients in poor neurological g rade after SAH are a heterogenous group both clinically and neuroradio logically. Management approaches must consider the cause of clinical d eterioration and the related CT findings.