Neurological grades of patients with poor-grade subarachnoid hemorrhage improve after short-term pretreatment

OBJECTIVE: Shout-term pretreatment of patients with subarachnoid hemorrhage , but without hematomas causing mass effect, who presented in poor neurolog ical condition at admission was evaluated as a protocol for the selection o f candidates for radical surgery. METHODS: One hundred-three patients were pretreated for 12 hours with contr ol of blood pressure and intracranial pressure, using diuretic agents and/o r ventricular drainage. RESULTS: Neurological improvement was observed for 32 of 47 patients in Gra de IV at admission and 23 of 56 patients in Grade V (P < 0.01). Hydrocephar us requiring drainage was more common (P < 0.05) and the interval between o nset and admission was shorter (P < 0.01) for the improved group. Clipping surgery was performed for all patients in Grade III or better and for patie nts in Grade IV who were less than 75 years of age and without systemic com plications, i.e., 38 of 47 patients in Grade (V and 16 of 56 patients in Gr ade V at admission. Good outcomes (defined as moderately disabled or better on the Glasgow Outcome Scale) were achieved by 34 of 38 patients in Grade IV and 10 of 16 patients in Grade V (P < 0.01). The proportion of patients in Grade IV after pretreatment was lower for Grade IV (2 of 38 patients) th an for Grade V (9 of 16 patients) (P < 0.00001). However, none of the 49 pa tients who underwent nonsurgical treatment achieved good outcomes. CONCLUSION: Our protocol may be beneficial for the selection of candidates for radical surgery among patients with subarachnoid hemorrhage but without hematomas who are in poor neurological condition at admission and for the improvement of postoperative outcomes.