Clinical Significance of Hemorrhage Location in Poor Grade Aneurysm Patients.

Kang, Sung Don

Original Article

Journal of Korean Neurosurgical Society 1996;25(4): 714-719.

Department of Neurosurgery, School of Medicine, Wonkwang University, Iri, Korea.

ABSTRACT

Many factors contributing to outcome of aneurysmal rupture patients have been studied but clinical significance of hemorrhage location based on CT in poor grade aneurysm(Hunt-Hess grade IV or V) patients is still unclear. The study was undertaken in order to try to outline the relative influence of hemorrhage location upon eventual outcome in poor grade patients with aneurysmal subarachnoid hemorrhage(SAH). Sixty-six SAH patients with early aneurysm surgery during the recent 3.5-year period, who were grouped into patients with intraventricular hemorrhage(IVH), intracerebral hematoma(ICH), ICH combined with IVH(ICH+IVH), and SAH according to hemorrhage locations were comparatively analyzed. Most of the poor grade patients(84.8%) were associated with ICH or IVH and the high frequency(67.9%) of IVH patients had an associated with ICH in contrast with the small number(32.1%) of pure IVH. Outcome was good in 26(39.4%) and poor in 40(60.6%). The presence of ICH on initial CT revealed better outcome compared to patients without ICH(60.7% vs 23.7%) However, ICH+IVH revealed poor outcome compared to patients without ICH+IVH(100% vs 44.7%). Ruptured anterior cerebral aneurysm caused an ICH+IVH more frequently and consequently more poor outcome than aneurysms in other anterior circulation. Additionally we relatively compared surgical outcome between aneurysmal sylvian or temporoparietal hematoma(ICH+sylvian or t-p) and hypertensive putaminal hematoma(H-ICH-putamen) sampled randomly under the similar conditions as much as motor weakness)was significantly lower in patients with aneurysmal ICH-sylvian or t-p(8.7% vs 50.0%). Overall results suggest that in Hunt-Hess IV-V aneurysm patients IVH itself does not independently correlate with prognosis, but when associated with an ICH it is related to a grave prognostic significance, and aggressive surgery for ICH lead to a better outcome with less morbidity.

Key Words: Aneursm; Poor grade; Hemorrhage location; Intracerebral hematoma; Intraventricular hemorrhage; Outcome