SIGNIFICANCE OF PUPILLARY REACTIVITY IN POOR-GRADE ANEURYSM PATIENTS AS A PROGNOSTIC FACTOR AND AN INDICATION FOR ACTIVE TREATMENT

Sixty-eight patients with subarachnoid haemorrhage (SAH) who were admi tted in a comatose state were studied to determine the factors influen cing mortality and to seek criteria for case management. Overall, the functional recovery (good recovery or moderate disability) rate was 33 %, with a mortality rate of 50%. Bilaterally unreactive pupils on admi ssion was a powerful predictor of death (p <0.0001): outcome of these patients was poor regardless of any treatment modalities with a mortal ity rate of 91% (20/22). Initial poor motor response (abnormal flexion , extension, or nil) was also significantly related with death (p <0.0 5). However, motor response was a less powerful predictor than pupilla ry reactivity. Motor response often altered spontaneously during the 1 2 h after admission, whereas pupillary reactivity tended to be stable. Initial reactive pupils were shown to be an indicator of spontaneous improvement of motor response. These findings indicate that pupillary reactivity may be a reliable predictor of outcome in poor-grade SAH pa tients.