Moreover, the risk of developing vasospasm progressively increases with each grade of the modified Fisher scale. Whereas the risk was highest for grade 3 and then decreased for grade 4 while using the original Fisher scale. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Updating… Please wait.
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Fisher revised scale for assessment of prognosis in patients with subarachnoid hemorrhage. Sequential neurological examinations and Hunt and Hess HaH score were performed on the 1 st , 7 th and 14 th days. Transcranial Doppler was used to assess vasospasms. Key words: subarachnoid hemorrhage, intracranial vasospasm, prognosis.
Subarachnoid hemorrhage SAH due to ruptured aneurysm is a vascular disease that has been the target of several investigations and discussions because of its high mortality and significant morbidity According to the majority of studies, the maximum frequency of VSP can be seen between 6 and 8 days after the event.
It rarely occurs more than 17 days after the event, with gradual resolution after around 2 to 4 weeks 6. The intensity of bleeding observed in the subarachnoid space on computed tomography CT has a strong relationship with the development of VSP and delayed neurological deficit DND 5, Its importance is evident in identifying patients at higher risk of developing clinical VSP, and indicates more aggressive and more accurate observation.
This tomographic grading is divided into four groups, such that grade 3 is most related to the presence of VSP both clinically and through angiography.
Despite identification of patients with dense SAH FS-3 , which has a high chance of progressing to worsened cerebral ischemia, FS does not provide differentiation between the prognoses for intraventricular hemorrhage IVH and parenchymal hemorrhage IPH , which are both classified as grade 4. Claassen et al. Moreover, they evaluated whether the presence of blood in both lateral ventricles had any significant value in predicting occurrences of clinical VSP.
The proposed scale is divided into five grades, with a progressive increase in the chance of developing worsening of cerebral ischemia in each subsequent grade. We conducted a prospective study on patients admitted to our Emergency Unit between January and December We included in the study all patients diagnosed with non-traumatic SAH determined using CT or CSF for whom the diagnosis was given not more than 72 hours after the hemorrhagic event.
To compare the effectiveness between the two proposed scales, the first CT scan was evaluated by the same examiner, with grading according to FS and FRS. Sequential neurological examinations were performed using the Glasgow Coma Scale GCS and the Hunt and Hess HaH score on the 1 st , 7 th and 14 th days, or when there was worsening of neurological status, in order to confirm the presence of DND.
In such cases, a CT scan was always performed to rule out other complications rebleeding or hydrocephalus and a TCD was done to confirm the relationship between symptoms and VSP. We studied 24 patients, consisting of five males Among this total of 24 patients, ten We observed that DND occurred in For data assessed using FS, we observed that there was a high frequency of patients graded as FS-4, which evolved with DND up to the fourteenth day This finding conflicts with the original work developed by Fisher, who showed a low risk of developing VSP.
We graded a patient with mild bleeding in one of the lateral ventricles in the same way as we graded another patient with bilateral hemorrhage. When we assessed the FRS, we observed a correlation with the data obtained by Claassen et al.
Among the six patients graded FRS-4, five Thus, the FRS clarifies the worsening of the prognosis according to the increasing grade.
These lower values may be due to achieving a greater number of serial CT scans, with a greater chance of excluding patients who developed neurological worsening for reasons rebleeding or hydrocephalus other than the VSP.
In our study, two out of seven patients graded as FS-3 From these data, it can be seen that the FRS may be better at identifying patients who are at risk of developing clinical VSP and neurological worsening. This finding is possibly due to the greater capacity of FRS-3 to detect patients with dense SAH with some degree of IVH that is not bilateral but is more likely to develop DND, while FS-3 excludes any possibility of the presence of blood in the lateral ventricles.
In another study on another change in the Fisher scale, there was higher incidence of vasospasm in patients with diffuse cisternal and ventricular hemorrhage, while mortality was higher among patients with ventricular hemorrhage and intracerebral hematoma These studies on changes to the Fisher scale indicate that there is a need for adjustments in order to achieve greater clinical correlation. This statement is most consistent when comparing grades 3 and 4 of the two scales. The presence of blood in both lateral ventricles was important for diagnosing these patients with poor prognosis especially when we have a thick SAH.
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Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage, the fisher scale revisited. Azevedo-Filho HR. Natural history of aneurismal subarachnoid hemorrhage and risk factors of rebleeding. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.
Services on Demand Journal. Vergueiro, sl. How to cite this article.
Escala de Hunt y Hess
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