J Korean Neurosurg Soc.  2012 May;51(5):268-271. 10.3340/jkns.2012.51.5.268.

Grading of Intracerebral Hemorrhage in Ruptured Middle Cerebral Artery Aneurysms

• Shim YS
• Moon CT
• Chun YI
• Koh YC

• KMID: 2066924
• DOI: http://doi.org/10.3340/jkns.2012.51.5.268

Abstract

OBJECTIVE
To propose grading of intracerebral hemorrhage (ICH) in ruptured middle cerebral artery (MCA) aneurysms, which helps to predict the prognosis more accurately.
METHODS
From August 2005 to December 2010, 27 cases of emergent hematoma evacuation and aneurysm clipping for MCA aneurysms were done in the author's clinic. Three variables were considered in grading the ICH, which were 1) hematoma volume, 2) diffuse subarachnoid hemorrhage (SAH) that extends to the contralateral sylvian cistern, and 3) the presence of midline shifting from computed tomography findings. For hematoma volume of greater than 25 mL, we assigned 2 points whereas 1 point for less than 25 cc. We also assigned 1 point for the presence of diffuse SAH whereas 0 point for the absence of it. Then, 1 point was assigned for midline shifting of greater than 5 mm whereas 0 point for less than 5 mm.
RESULTS
According to the grading system, the numbers of patients from grade 1 to 4 were 4, 6, 8 and 9 respectively and 5, 7, 8, 4 and 3 patients belonged to Glasgow Outcome Scale (GOS) 5 to 1 respectively. It was found that the patients with higher GOS had lower ICH grade which were confirmed to be statistically significant (p<0.01). Preoperative Hunt and Hess grade and absence of midline shifting were the factors to predict favorable outcome.
CONCLUSION
The ICH grading system composed of above three variables was helpful in predicting the patient's outcome more accurately.

Keyword

Subarachnoid hemorrhage; Middle cerebral artery aneurysm; Intracerebral hemorrhage

MeSH Terms

Aneurysm
Cerebral Hemorrhage
Glasgow Outcome Scale
Hematoma
Humans
Intracranial Aneurysm
Middle Cerebral Artery
Prognosis
Subarachnoid Hemorrhage

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