Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage

Czorlich, Patrick; Ricklefs, Franz; Reitz, Matthias; Vettorazzi, Eik; Abboud, Tammam; Regelsberger, Jan; Westphal, Manfred; Schmidt, Nils Ole

doi:10.1007/s00701-014-2334-z

Cited by 48 publications

(26 citation statements)

References 38 publications

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“…The incidence of aneurysmal SAH is approximately 7 per 100,000. 2 Overall outcome remains poor; the 30-day mortality rate can be as high as one-third of patients in prior studies, while survivors may continue to demonstrate significant long-term morbidity. diographic findings (Fisher score), and clinical course (early hydrocephalus requiring an external ventricular drain, vasospasm, and aneurysmal rehemorrhage).…”

Section: Discussionmentioning

confidence: 99%

“…8,14,30,34,37 The presence, extent, and distribution of IVH have been associated with a poor prognosis. 2,6,25,34 Furthermore, the clearance of IVH with tissue plasminogen activator has been the target of ongoing studies. 11,12 Although qualitative scores (original and modified Fisher grade, 3 LeRoux score, 15 and original and modified Graeb scores 1,6,21 ) have been established for evaluating SAH and IVH, assessment of hemorrhage qualitatively can be inconsistent and imprecise.…”

Section: Discussionmentioning

confidence: 99%

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Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Nguyen¹,

Li²,

Patel³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE The presence, extent, and distribution of intraventricular hemorrhage (IVH) have been associated with negative outcomes in aneurysmal subarachnoid hemorrhage (SAH). Several qualitative scores (Fisher grade, LeRoux score, and Graeb score) have been established for evaluating SAH and IVH. However, no study has assessed the radiodensity within the ventricular system in aneurysmal SAH patients with IVH. Prior studies have suggested that hemorrhage with a higher radiodensity, as measured by CT Hounsfield units, can cause more irritation to brain parenchyma. Therefore, the authors set out to investigate the relationship between the overall radiodensity of the ventricular system in aneurysmal SAH patients with IVH and their clinical outcome scores. METHODS The authors reviewed the records of 101 patients who were admitted to their institution with aneurysmal SAH and IVH between January 2011 and July 2015. The following data were collected: age, sex, Glasgow Coma Scale (GCS) score, Hunt and Hess grade, extent of SAH (none, thin, or thick/localized), aneurysm location, and Glasgow Outcome Scale (GOS) score. To evaluate the ventricular radiodensity, the initial head CT scan was loaded into OsiriX MD. The ventricular system was manually selected as the region of interest (ROI) through all pertinent axial slices. After this, an averaged ventricular radiodensity was calculated from the ROI by the software. GOS scores were dichotomized as 1-3 and 4-5 subgroups for analysis. RESULTS On univariate analysis, younger age, higher GCS score, lower Hunt and Hess grade, and lower ventricular radiodensity significantly correlated with better GOS scores (all p < 0.05). Subsequent multivariate analysis yielded age (OR 0.936, 95% CI 0.895-0.979), GCS score (OR 3.422, 95% CI 1.9-6.164), and ventricular density (OR 0.937, 95% CI 0.878-0.999) as significant independent predictors (p < 0.05). A receiver operating characteristic curve yielded 12.7 HU (area under the curve 0.625, p = 0.032, sensitivity = 0.591, specificity = 0.596) as threshold between GOS scores of 1-3 and 4-5. CONCLUSIONS This study suggests that the ventricular radiodensity in aneurysmal SAH patients with IVH, along with GCS score and age, may serve as a predictor of clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Nguyen¹,

Li²,

Patel³

et al. 2018

Journal of Neurosurgery

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“…Different quantitative techniques and qualitative scales have been implemented to quantify the amount of subarachnoid and intraventricular blood and have previously been validated for aSAH by many authors. 3,[5][6][7]24 Volumetric measurement of blood volume is more precise and informative 17 and has been classically considered the most accurate tool to evaluate prognostic implications. 18,23 However, this quantitative method requires specific software, training, and a research setting not widely available in every clinical location.…”

Section: Discussion Predicting Sdhc After Sahmentioning

confidence: 99%

Quantitative versus qualitative blood amount assessment as a predictor for shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage

García

Torné

Hoyos

et al. 2019

Journal of Neurosurgery

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OBJECTIVEReliable tools are lacking to predict shunt-dependent hydrocephalus (SDHC) development after aneurysmal subarachnoid hemorrhage (aSAH). Quantitative volumetric measurement of hemorrhagic blood is a good predictor of SDHC but might be impractical in the clinical setting. Qualitative assessment performed using scales such as the modified Fisher scale (mFisher) and the original Graeb scale (oGraeb) is easier to conduct but provides limited predictive power. In between, the modified Graeb scale (mGraeb) keeps the simplicity of the qualitative scales yet adds assessment of acute hydrocephalus, which might improve SDHC-predicting capabilities. In this study the authors investigated the likely capabilities of the mGraeb and compared them with previously validated methods. This research also aimed to define a tailored mGraeb cutoff point for SDHC prediction.METHODSThe authors performed retrospective analysis of patients admitted to their institution with the diagnosis of aSAH between May 2013 and April 2016. Out of 168 patients, 78 were included for analysis after the application of predefined exclusion criteria. Univariate and multivariate analyses were conducted to evaluate the use of all 4 methods (quantitative volumetric assessment and the mFisher, oGraeb, and mGraeb scales) to predict the likelihood of SDHC development based on clinical data and blood amount assessment on initial CT scans.RESULTSThe mGraeb scale was demonstrated to be the most robust predictor of SDHC, with an area under the curve (AUC) of 0.848 (95% CI 0.763–0.933). According to the AUC results, the performance of the mGraeb scale was significantly better than that of the oGraeb scale (χ2 = 4.49; p = 0.034) and mFisher scale (χ2 = 7.21; p = 0.007). No statistical difference was found between the AUCs of the mGraeb and the quantitative volumetric measurement models (χ2 = 12.76; p = 0.23), but mGraeb proved to be the simplest model since it showed the lowest Akaike information criterion (66.4), the lowest Bayesian information criterion (71.2), and the highest R2Nagelkerke coefficient (39.7%). The initial mGraeb showed more than 85% specificity for predicting the development of SDHC in patients presenting with a score of 12 or more points.CONCLUSIONSAccording to the authors’ data, the mGraeb scale is the simplest model that correlates well with SDHC development. Due to limited scientific evidence of treatments aimed at SDHC prevention, we propose an mGraeb score higher than 12 to identify patients at risk with high specificity. This mGraeb cutoff point might also serve as a useful prognostic tool since patients with SDHC after aSAH have worse functional outcomes.

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“…Aneurysmal intracerebral hematoma (ICH) is strongly associated with poorer functional outcome and seems to be predictable even before the bleeding event [1][2][3]. Aneurysms from distal anterior cerebral and middle cerebral artery are most likely to produce ICH and intraventricular hemorrhage (IVH) [4][5][6]. Intracerebral hematomas complicate 34% of aneurysm cases [7,8].…”

Section: Discussionmentioning

confidence: 99%

Excellent Outcome after Early Surgery for Ruptured Middle Cerebral Artery Aneurysm Complicated with Intracerebral and Intraventricular Hemorrhage: A Case Report

Filipče¹,

Caparoski²,

Kamiloski³

et al. 2015

Macedonian Medical Review

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Intracerebral hematoma and intraventricular hemorrhage can significantly worsen the neurological condition of patients with subarachnoid hemorrhage due to ruptured intracranial aneurysm. They also significantly affect the outcome of this patiens. We present a case in which early surgery had a significant effect on the outcome of this patient. Early decompression of the brain and subsequent clipping of the aneurysm as presented in our case has lead to a successful outcome.

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Impact of intraventricular hemorrhage measured by Graeb and LeRoux score on case fatality risk and chronic hydrocephalus in aneurysmal subarachnoid hemorrhage

Abstract: Graeb or LeRoux scores improve the prediction of shunt dependency and in parts of CFR in aneurysmal SAH patients therefore confirming the relevance of the extent and distribution of intraventricular blood for the clinical course in SAH.

Cited by 48 publications

References 38 publications

Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Radiodensity of intraventricular hemorrhage associated with aneurysmal subarachnoid hemorrhage may be a negative predictor of outcome

Quantitative versus qualitative blood amount assessment as a predictor for shunt-dependent hydrocephalus following aneurysmal subarachnoid hemorrhage

Excellent Outcome after Early Surgery for Ruptured Middle Cerebral Artery Aneurysm Complicated with Intracerebral and Intraventricular Hemorrhage: A Case Report

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