gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Early neurological improvement and deterioration after aneurysmal subarachnoid hemorrhage: When should clinical assessment be performed to predict outcome?

Frühe neurologisch-klinische Veränderung nach aneurysmatischer SAB: Bestimmung des Zeitpunktes der Klassifizierung für eine optimale prädiktive Aussage

Meeting Abstract

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  • corresponding author J. Liersch - Neurochirurgische Klinik, Universitätsklinikum, Düsseldorf
  • D. Hänggi - Neurochirurgische Klinik, Universitätsklinikum, Düsseldorf
  • H.-J. Steiger - Neurochirurgische Klinik, Universitätsklinikum, Düsseldorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.135

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Liersch et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: WFNS and Hunt&Hess grading scales are used to estimate the severity of subarachnoid hemorrhage (SAH) and to forecast ultimate outcome. Early improvement as well as deterioration is common. A standardized time interval for clinical grading of SAH appears therefore mandatory. In the current study we correlated the neurological course within the first 72 hours after admission and Fisher grading with outcome.

Methods: The prospectively acquired data of 104 patients with aneurysmal SAH admitted to hospital between February 2004 and September 2005 were included in this analysis. WFNS grade was determined six times within the first 72 hours. Fisher and Hunt&Hess score were determined at admission. Outcome was assessed by the Rankin score at time of hospital discharge. We compared the initial clinical grades with those measured during the following 72 hours. In case of divergence the underlying features were analysed individually. Statistical correlation was computed by chi2-tests.

Results: Out of 104 patients 7 patients (7%) improved from WFNS IV to WFNS II, 4 patients (4%) from WFNS IV to I, and 4 patients (4%) changed from WFNS III to I. The underlying features for improvement were the occurrence of early seizures (5%), drainage of hydrocephalus (4%), evacuation of an intracranial hematoma (2%) and unkown reasons (4%). Seven patients initially admitted in good grade (WFNS I or II) deteriorated to poor grades (WFNS IV or V) due to secondary complications like rebleeding (3%), treatment associated ischemia (2%) and systemic complications (2%). Outcome at discharge was found to be optimally predicted by the best WFNS measured within 24 to 48 hours after admission (r= 0,796). Fisher, H&H and the initial WFNS correlated with outcome less closely than the best WFNS on the second day (Fisher r=0,278, H&H r=0,606, initial WFNS r=0,595).

Conclusions: With regard to a more reliable outcome prediction we propose to select the best WFNS grade during the second day after admission as the basis for assessment. The only negative aspect of this approach is that the potential negative impact of therapy cannot be completely separated from the initial insult. This aspect, however, appears to have little practical relevance.