Purpose
Non-traumatic subarachnoid haemorrhage (SAH) is caused by the rupture of an intracranial aneurysm in 85% of cases(1) and cerebral vasospasm is the leading cause of death and disability in patients with aneurysmal SAH (aSAH) (2).
Despite much research having focused on this potentially devastating complication,
it is still incompletely understood.
Grading scales for SAH abound,
and include :
Fisher scale
Modified Fisher scale
World Federation of Neurosurgeons scale (WFNS)
Hunt and Hess scale
Hijdra sum score
Glasgow Coma Scale
The Fisher scale (see Table 1):...
Methods and Materials
Study Design:
Retrospective cohort study including all patients who presented to the Royal Brisbane and Women’s Hospital with aSAH between October 2007 and October 2010 that subsequently underwent an endovascular coiling procedure to secure the ruptured aneurysm,
and did not also undergo surgical management (113 patients)
Outcome of interest
endovascular treatment for delayed cerebral vasospasm (ie.
intra-arterial (IA) verapamil infusion with or without angioplasty)
Patients were identified from departmental records,
data was collected from PACS using an in-house search engine,
images and radiology reports
Diagnosis...
Results
General numbers:
112 patients with aneurysmal SAH treated with coiling were included
29 (25.9%) developed angiographic vasospasm
23 (20.5%) were treated with IA verapamil or angioplasty
Age and sex had no relationship to outcome in this study (41 males,
71 females,
age range 15 to 82)
Fisher score:
A trend is evident but this is not sufficient for an association (see Table 3)
Patients with high Fisher scores (4) had an odds ratio for developing vasospasm of 1.9 (Cl: 0.61,
5.96) compared to patients with...
Conclusion
A simple summed Fisher and WFNS score shows promise as a predictor of likelihood of developing vasospasm after SAH,
however in this small cohort statistical significance was not reached.
A trend was demonstrated between a higher Fisher score and risk of developing vasospasm however,
again,
in this small cohort,
there was not statistical weight to support an association.
A larger prospective study is warranted to further explore these findings.
Personal Information
Professor Alan Coulthard is a Professor of Neuroradiology at the University of Queensland,
Head of the UQ Discipline of Medical Imaging and Senior Staff Specialist in the Department of Medical Imaging at the Royal Brisbane and Women’s Hospital. His qualifications include BMedSci,
MBBS,
FRCSEd,
FRCR and FRANZCR.
Dr Annah Lane is a full time research officer in the Department of Medical Imaging and Research at the Royal Brisbane and Women’s Hospital. Her qualifications include MBBS and BSc. She is applying for the 2012 intake into...
References
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Kerr RS,
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Subarachnoid haemorrhage.
Lancet 2007;369:306-318
2. Kassell NF,
Sasaki T,
Colohan AR,
Nazar G.
Cerebral vasospasm following aneurysmal subarachnoid hemorrhage.
Stroke 1985;16:562-572
3. Fisher CM,
Kistler JP,
Davis JM.
Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning.
Neurosurgery 1980;6:1-9
4. Kistler JP,
Crowell RM,
Davis KR,
et al.
The relation of cerebral vasospasm to the extent and location of subarachnoid blood visualized by CT scan: a prospective study.
Neurology 1983;33:424-436
5. Reilly C,
Amidei...