A Comparison of Computed Tomography-Based Scales with and without Consideration of the Presence or Absence of Intraventricular Hemorrhage in Patients with Aneurysmal Subarachnoid Hemorrhage.

OBJECTIVE: There has been controversy as to whether intraventricular hemorrhage (IVH) after aneurysmal subarachnoid hemorrhage (SAH) contributes to angiographic cerebral vasospasm (aCV) and delayed cerebral ischemia (DCI). Computed tomography-based SAH scales that did and did not consider IVH were compared in terms of ability to predict aCV, DCI, and outcome.

METHODS: We reviewed 390 patients with ruptured aneurysms who had been treated surgically by day 3 by the same surgeon (T.I.). aCV was graded as 0-4. Outcome at 6 months was classified using the Glasgow Outcome Scale. Inagawa SAH grades and scores, for which only SAH was evaluated, were compared with scales that evaluated both SAH and IVH (Fisher, Claassen, and Frontera grades, and Hijdra score). The area under the receiver operating characteristic curve was calculated to compare severe aCV (grade 3-4), DCI, or poor outcome (Glasgow Outcome Scale score 1-3).

RESULTS: The Inagawa grade showed constant and significant intergrade differences in both aCV and DCI. The Inagawa grade area under the receiver operating characteristic curve values were highest among the scales examined. In the Fisher, Claassen, and Frontera grades, IVH was unlikely to be related to aCV and DCI. There was no significant difference in aCV grade or DCI occurrence between the Inagawa and Hijdra scores. In contrast, the presence of IVH was significantly associated with poor outcome.

CONCLUSIONS: In patients with aneurysmal SAH, IVH is an important factor affecting patient outcome, whereas computed tomography-based SAH scales that do not consider IVH are superior to scales that do consider it for prediction of aCV or DCI.