A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies.

Teasdale, Graham M.; Drake, Cg; Hunt, William; Kassell, Neal F.; Sano, Keiji; Pertuiset, B; Villiers, J. C. De

doi:10.1136/jnnp.51.11.1457

Cited by 619 publications

(310 citation statements)

References 3 publications

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“…The clinical condition of all patients was classified according to the World Federation of Neurosurgical Societies scale (WFNS) [7,17]. Clinical outcome was graded according to the modified Rankin scale [2,15].…”

Section: Methodsmentioning

confidence: 99%

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

et al. 2011

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Objective In recent years the endovascular treatment of intracranial aneurysms (coiling) has progressively gained recognition, particularly after the publication of the International Subarachnoid Aneurysm Trial (ISAT) in 2002. Despite the fact that in ISAT middle cerebral artery (MCA) aneurysms were clearly underrepresented, the study is often used as an argument to favor coiling above surgery in MCA aneurysms. Taken into account that MCA aneurysms are very well accessible for surgery, a contemporary assessment of the benefits of a preferred surgical strategy for MCA aneurysms was performed in a tertiary neurovascular referral center. Methods A prospectively kept single-center database of 151 consecutive patients with an MCA aneurysm was reviewed over a 6-year period (2001)(2002)(2003)(2004)(2005)(2006). Long-term follow-up after surgical treatment of a ruptured MCA aneurysm was obtained in 74 out of 77 (96%) patients. The outcome was compared with relevant series in the literature.Results After a mean follow-up of 4.7 years, 59 out of 74 surgically treated patients (80%) with a ruptured MCA aneurysm had a good outcome (mRankin 0-2). All patients with an unruptured MCA aneurysm also had a good outcome after clipping. This is well-matched with the findings of the literature search, and competitive with the endovascular results.Conclusion Surgical clipping is recommended as the principal treatment strategy for MCA aneurysms. This is not only ethically defendable in view of the surgical results but also in line with a strategy to maintain surgical experience within centralized neurovascular centers.

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Section: Methodsmentioning

confidence: 99%

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

et al. 2011

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“…Clinical severity was independently graded based on the clinical history and examination findings at presentation according to the World Federation of Neurosurgical Societies (WFNS) scoring system (14). Admission CT brain scans were reviewed by one of two radiologists who were blinded to the clinical condition of the patient and Fisher scale recorded (15) ( Table 1).…”

Section: Clinical and Radiological Markers Of Severity Of Sahmentioning

confidence: 99%

Low prevalence of hypopituitarism after subarachnoid haemorrhage using confirmatory testing and with BMI-specific GH cut-off levels

Gardner

Javadpour

Stoneley

et al. 2013

European Journal of Endocrinology

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Objective: Hypopituitarism following subarachnoid haemorrhage (SAH) has been reported to be a frequent occurrence. However, there is considerable heterogeneity between studies with differing patient populations and treatment modalities and most importantly employing differing endocrine protocols and (normal) reference ranges of GH. We aimed to examine prospectively a cohort of SAH survivors for development of hypopituitarism post-SAH using rigorous endocrine testing and compare GH response to glucagon stimulation with a cohort of healthy controls of a similar BMI. Design and methods: Sixty-four patients were investigated for evidence of hypopituitarism 3 months post-SAH with 50 patients tested again at 12 months. Glucagon stimulation testing (GST), with confirmation of deficiencies by GHRH/arginine testing for GH deficiency (GHD) and short synacthen testing for ACTH deficiency, was used. Basal testing of other hormonal axes was undertaken. Results: Mean age of patients was 53G11.7 years and mean BMI was 27.5G5.7 kg/m 2 . After confirmatory testing, the prevalence of hypopituitarism was 12% (GHD 10%, asymptomatic hypocortisolaemia 2%). There was no association between hypopituitarism and post-SAH vasospasm, presence of cerebral infarction, Fisher grade, or clinical grading at presentation. There was a significant correlation between BMI and peak GH to glucagon stimulation in both patients and controls. Conclusions: Identification of 'true' GHD after SAH requires confirmatory testing with an alternative stimulation test and application of BMI-specific cut-offs. Using such stringent criteria, we found a prevalence of hypopituitarism of 12% in our population.

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“…All patients were classified as World Federation of Neurosurgical Societies (WFNS) grades I to IV 30) and Hunt and Kosnik (H & K) grades I to IV, 13) and underwent surgery for ruptured aneurysms within 3 days (Table 1). Exclusion criteria included the following: pregnancy; age of less than 20 or more than 75 years; absence of a subarachnoid clot on computed tomography (CT) at admission; massive intraventricular and/or intracerebral hematoma on CT at admission; obvious low-density areas on CT at admission; arterial stenosis due to cerebral vasospasm on angiography at admission; severe complications, such as cardiopulmonary, hepatorenal, or metabolic diseases; and administration of ticlopidine hydrochloride, sodium ozagrel, fasudil hydrochloride, nizofenone fumarate, aspirin, dipyridamole, trapidil, or calcium antagonists except for treatment of hypertension immediately prior to the onset of SAH.…”

Section: Selection Of Patientsmentioning

confidence: 99%

“…Clinical, radiological, and laboratory assessments On admission the patient's clinical grade was classified according to the WFNS 30) and H & K 13) scales. SAH severity was graded on CT according to the 29) and the Japan Coma Scale, 21) as well as motor and speech functions as determined by an objective scale, 27) were performed prior to drug administration, daily during drug treatment, and at 1 month after SAH.…”

Section: Drug Administrationmentioning

confidence: 99%

Effect of a Platelet-Activating Factor Receptor Antagonist, E5880, on Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage. Open Clinical Trial to Investigate Efficacy and Safety.

Hirashima

Endo

Nukui

et al. 2001

Neurol. Med. Chir.(Tokyo)

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The efficacy and safety of a new platelet-activating factor receptor antagonist, E5880, were investigated for preventing cerebral vasospasm after subarachnoid hemorrhage (SAH) in 71 patients with SAH who underwent surgery for ruptured aneurysms within 3 days. Intravenous E5880 administration (300 mg or 1200 mg twice daily) was begun within 4 days and continued for 14 days. The incidence of symptomatic vasospasm, low-density area on computed tomography, and angiographic vasospasm was lower than in placebo groups in previous studies. Clinical outcome was favorable compared with previous studies. No clinically important adverse events were observed. These results suggest that E5880 is safe and effective in the treatment of patients with cerebral vasospasm due to SAH.

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A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurosurgical Societies.

Cited by 619 publications

References 3 publications

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Surgical clipping as the preferred treatment for aneurysms of the middle cerebral artery

Low prevalence of hypopituitarism after subarachnoid haemorrhage using confirmatory testing and with BMI-specific GH cut-off levels

Effect of a Platelet-Activating Factor Receptor Antagonist, E5880, on Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage. Open Clinical Trial to Investigate Efficacy and Safety.

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