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CT assessment of subarachnoid haemorrhage. A comparison between different CT methods of grading subarachnoid
A Forssell1, C Larsson, J Rönnberg
1Department of Diagnostic Radiology, University of Umë, Sweden.
Insights
This study found that the extent of subarachnoid hemorrhage (SAH) on CT scans, not just localized clots, strongly predicts delayed ischemic deficits. A specific scoring system highlights the importance of widespread SAH in predicting patient outcomes.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Subarachnoid hemorrhage (SAH) is a critical neurological condition often caused by ruptured aneurysms.
- Predicting delayed ischemic deficits (DID) following aneurysmal SAH is crucial for patient management.
- Computed Tomography (CT) is a primary imaging modality for SAH assessment.
Purpose of the Study:
- To evaluate various CT classification systems for subarachnoid hemorrhage (SAH).
- To identify the CT grading system that best correlates with the development of delayed ischemic deficits (DID) in patients with aneurysmal SAH.
- To understand the relationship between SAH extent and DID.
Main Methods:
- Application of multiple CT classification systems to a series of 50 patients with aneurysmal SAH.
- Correlation analysis between CT grades and the occurrence of delayed ischemic deficits (DID).
- Development of a novel scoring system based on cisternal SAH grades.
Main Results:
- A specific CT scoring method, summing individual cisternal grades (excluding the cortical subarachnoid space), showed the strongest correlation with DID.
- The overall extent of SAH on CT was a more significant predictor of DID than localized clot presence.
- Findings suggest that widespread SAH is a key factor in DID development.
Conclusions:
- The proposed CT scoring system effectively predicts DID in aneurysmal SAH.
- The extent of SAH, particularly in the cisterns, is more critical for DID development than focal clot burden.
- This emphasizes the prognostic value of assessing the overall SAH distribution on CT scans.
Abstract:
A number of different CT classifications of subarachnoid haemorrhage (SAH) were applied to a consecutive series of 50 patients with aneurysmal SAH. The best correlation with delayed ischaemic deficits (DID) was obtained with a score formed by the sum of the individual cisternal grades except that of the cortical subarachnoid space. The findings emphasize the significance of the extent of the SAH, rather than the presence of a localized cisternal clot with regard to the development of DID.