gms | German Medical Science

Objective: In 2012 a new CT grading scale was introduced by the Barrow Neurological Institute (“BNI scale”) to predict angiographic and symptomatic vasospasm in aneurysmal subarachnoid hemorrhage (aSAH). So far, the prognostic value of the BNI scale concerning cerebral infarction and patient outcome has not yet been evaluated.

Method: Consecutive data of 260 patients with aSAH were retrospectively analyzed with respect to angiographic vasospasm, BNI grade, Fisher score, presence of intracerebral hemorrhage (ICH) and intraventricular hemorrhage (IVH) at CT on admission. Cerebral infarction and patient outcome using the modified Rankin score (mRS) were assessed in relation to BNI and Fisher grades.

Results: Patients presenting with more severe BNI grades were older (p=0.024), displayed lower GCS at admission (p≤0.001) and were more often diagnosed with IVH (p≤0.001). Increasing BNI grade was associated with occurrence of new cerebral ischemia (p≤0.001) and with poor patient outcome (p=0.007). In a multivariate analysis, BNI grade and the presence of ICH were significant independent risk factors for the development of new cerebral ischemia (OR: 1.588, CI: 1.196 - 2.138, p=0.002 and OR: 1.540, CI 1.174 - 2.045, p=0.003) and poor patient outcome (OR: 2.753, CI: 1.486 - 5.182, p=0.002 and OR: 3.403, CI: 1.844 - 6.427), while the presence of IVH showed no additional predictive value (OR: 1.323, 0.727 - 2.400, p=0.357 and OR: 1.655, CI 0.911 - 3.001, p=0.098).

Conclusions: In our patient cohort, the BNI grade and the presence of ICH were independent risk factors for new cerebral ischemia and poor patient outcome.