gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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

Meeting Abstract

  • Kerim Beseoglu - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Deutschland
  • Sven Eicker - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Deutschland
  • Hans-Jakob Steiger - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Deutschland
  • Daniel Hänggi - Neurochirurgische Klinik, Heinrich-Heine-Universität Düsseldorf, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1829

doi: 10.3205/10dgnc300, urn:nbn:de:0183-10dgnc3006

Published: September 16, 2010

© 2010 Beseoglu 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: Today WFNS grading scale is used to estimate the severity of subarachnoid hemorrhage (SAH) and to forecast ultimate outcome. Early neurological improvement as well as deterioration is common. A standardized time interval for clinical grading of SAH appears therefore mandatory. In this study we correlated the neurological course within the first 72 hours after admission with outcome.

Methods: Prospectively acquired data of 489 patients with aneurysmal SAH admitted to hospital between 2004 and 2009 were analysed. WFNS grade was determined six times within the first 72 hours. Fisher score was determined at admission. Outcome was assessed by Rankin score at time of discharge. We correlated all clinical grades with outcome. Statistical correlation was computed by χ2-test.

Results: 62 patients (12.6%) improved from a poor WFNS grade (IV or V) to a good WFNS grade (WFNS I or II) within 72 hours. Improvement occurred after drainage of hydrocephalus (n=24), recovering from initial seizure (n=33) or evacuation of intracerebral hematoma (n=5). 18 patients (3.7%) deteriorated in this period from good WFNS grade to poor WFNS grade due to cerebral infarction (n=7), rebleeding (n=6) or systemic complications (n=5). Outcome was best predicted by the WFNS grade measured within 36 to 48 hours after admission (r=0,832). Fisher grade and the initial WFNS correlated with outcome less closely (Fisher r=0,397, initial WFNS r=0,616).

Conclusions: With regard to a more reliable outcome prediction we propose to select the WFNS grade during the time period 36-48 hours after admission as the basis for assessment.