Angiographic scale for evaluation of cerebral vasospasm
Even when there is a CT scan classification for the evaluation of subarachnoid haemorrhage (SAH) and clinical outcome (Fisher’s scale), until now, there is not an angiographic scale currently in use that correlates the vasospasm extent with the clinical o
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Angiographic scale for evaluation of cerebral vasospasm E. Nathal1 , F. L opez-Gonza´lez1 , C. Rios2 1 2
Division of Neurosurgery, National Institute of Neurology and Neurosurgery, ‘‘Manuel Velasco Sua´rez’’, Mexico City, Mexico Cerebral Research Unit, National Institute of Neurology and Neurosurgery, ‘‘Manuel Velasco Sua´rez’’, Mexico City, Mexico
Summary Background. Even when there is a CT scan classification for the evaluation of subarachnoid haemorrhage (SAH) and clinical outcome (Fisher’s scale), until now, there is not an angiographic scale currently in use that correlates the vasospasm extent with the clinical outcome. Method. From March to November 2004, we analyzed 100 consecutive cases with the diagnosis of subarachnoid haemorrhage secondary to a ruptured aneurysm admitted to our hospital before 72 h from ictus. All patients underwent four-vessel angiography and CT scanning on admission. Angiography was repeated after surgical or endovascular treatment, and further CT scans were performed as considered necessary. The date of onset, the neurological grade on admission (Hunt and Kosnik), the occurrence of symptomatic vasospasm, the appearance of low density areas (LDA) on CT scans and the clinical outcome using the Glasgow Outcome Scale (GOS) were registered. Angiographic vasospasm was evaluated by three independent observers using our scale, which is defined as follows: grade 0, no evidence of vasospasm; grade 1, vasospasm in one vascular axis; grade 2, vasospasm in two vascular axes; grade 3, vasospasm in three vascular axes; and grade 4, generalized or diffuse vasospasm. The vascular axes were defined as follows: a) internal carotid artery, b) middle cerebral artery, c) anterior cerebral artery (pre- and post-communicating segments), d) vertebral artery, e) basilar artery, f) posterior cerebral artery, and g) any other arterial territory (e.g. posterior cerebellar artery, superior cerebellar artery). A correlation was made between the angiographic grade and the clinical condition of the patients at discharge from the hospital using the GOS. In addition, the predictive power was compared with that of the Fisher scale. Results and conclusions. We found that the scale correlates well with the vasospasm extent and clinical course and can be used alone or in combination with other scales in use for SAH. Keywords: Subarachnoid haemorrhage; angiographic scale; cerebral vasospasm; neurosurgery; cerebral aneurysm; neuroradiology.
Introduction Cerebral vasospasm is an important complication after subarachnoid haemorrhage that can lead to permanent neurological deficit [5, 6]. It occurs in about 40–70% of Correspondence: Edgar Nathal, MD, Division of Neurosurgery, National Institute of Neurology and Neurosurgery, ‘‘Manuel Velasco Suarez’’, Insurgentes Sur 3877, Tlalpan, 14269 Mexico, D.F. Mexico. e-mail: [email protected]
patients with SAH and symptomatic vasospasm can occur between 17 and 40% of these patients. Until now, there have been some reported scales to determine the neurological grade of the patients aft
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