Prognostic factors in delayed ischaemic deficit with vasospasm in patients undergoing early aneurysm surgery.

We have examined prognostic factors in delayed ischaemic deficit attributed to vasospasm following subarachnoid haemorrhage (SAH) and early aneurysm surgery. Among 605 patients with SAH, 201 patients developed a delayed ischaemic deficit and 137 of these underwent early surgery. These 137 patients were classified into groups A and B by outcome at 3 months after SAH (group A: the delayed ischaemic deficit was associated with an adverse outcome; group B: no adverse outcome). Factors indicating an unfavourable outcome were as follows: (i) older age; (ii) poor WFNS grade on admission; (iii) Fisher's scale of 4; (iv) intracerebral haemorrhage; (v) delayed ischaemic deficit following rerupture; (vi) complications of surgical intervention; (vii) delayed ischaemic deficit with disturbance of consciousness; (viii) lack of immediate improvement with hypervolaemic therapy; and (ix) intracranial complications after hypervolaemic therapy. We suggest that the reversibility of a delayed ischaemic deficit is determined by preceding brain damage and/or surgical complications.