Acta Neurochir (Wien) (1995) 132:I-8 =Acta-- N urochirurgica ~r Springer-Verlag 1995 Printed in Austria Level of Consciousness and Age as Prognostic Factors in Aneurysmal SAH R. Deruty, I. Pelissou-Guyotat, C. Mottolese, D. Amat, and L. Bognar H6pital Neurologique et Neuro-chirurgical, Lyon, France Summary The prognostic value of the level of consciousness and the pa- tient's age for the outcome of aneurysmal subarachnoid haemorrhage (SAH) is studied in 74 patients admitted on day (D) 0 to D 3 after aneurysm rupture. For the level of consciousness three groups of patients are com- pared: grade I + II (alert patients), grade III+ IV (drowsy patients), and grade V (comatose patients). For the age, two groups are com- pared: patients aged under 50, and patients aged 50 and over. The timing of surgery was: D0-D3 51%, D4-D6 20%, D7 and later 18%, and No surgery 11%. The overall management results were: Good (satisfactory result) 43%, Fair (moderately disabled) 18%, Poor (severely dis- abled + vegetative survival) 19%, and Death 20 %. The outcome was strongly related to the level of consciousness, the rates of Good result decreasing from 71% (grades I-II) to 14% (grades III-IV) and to zero (grade V), and the mortality rates increasing respectively from 5% to 14% and 61%. The relationship between outcome and age was less marked: 54% Good result under 50 and 30% over 50. Out of the Grade V group, 56% could be operated upon and 44% died before surgery. No patient from the other two groups died before surgery. The literature concerning the Grading Systems published so far and the various prognostic factors are discussed. Keywords: Aneurysm rupture; subarachnoid haemorrhage; tim- ing of surgery. Introduction The final outcome of the management of a ruptured aneurysm is far from easy to predict at the time of admission. As pointed out in the International Co- operative Study Report 12 there is a strong discrepancy between the expected management results and the ac- tual results. So far several factors have been accepted as of prognostic value at the time of admission: clinical factors (level of consciousness, age, associated dis- eases), and paraclinical factors (extent of blood as judged by the CT scan, vasospasm as seen on the an- giograms or on transcranial doppler evaluation, is- chaemia on CBF measurements). In this paper we investigate the prognostic value of the main two clinical parameters: the level of con- sciousness and the patient's age. Patients and Techniques During the 3 years between August 1990 and August 1993, 74 patients were admitted to our department on D0 to D 3 after an aneurysm rupture (average 25 patients per year). Admission Evaluation Tile clinical status at the time of admission was evaluated ac- cording to the following grading system, in 5 grades. Grade I: Patients being asymptomatic after SAH. Grade II: Patients with current signs of SAH (headache, neck stiffness, photophobia). No confusion, no neurological deficit except that relating to a cranial nerve. Grade III: Patients with mild obnubilation, disturbance of con- sciousness with or without focal neurological deficit. Grade IV: Patients with severe obnubilation, disturbance of con- sciousness (stuporous to semi-comatose) with or without focal neu- rological deficit. Grade V: Patients with deep coma, vegetatives disturbances with or without decerebrate rigidity. These 5 grades may be compared with the levels of consciousness reported in the Co-operative Study as follows: alert (grade I + II), drowsy (grade III), stuporous (grade IV) and comatose (grade V). At the time of admission, 42 out of our 74 patients were in grade I + II (57%), 14 were in grade III + IV (20%), and 18 were in grade V (24%). We will refer to these 3 groups for the outcome evaluation. As for age of the patients, we chose to compare patients under 50 years of age (41 patients, i.e. 55%) and aged 50 and over (33 patients, i.e. 45%). Amongst this latter group, 11 patients were 65 and over (15% of the whole series). Timing of Surgery As all 74 patients were admitted between D 0 to D 3 of aneurysm rupture, surgery was performed at different times. The timing of surgery in this study was split up into the following periods, D 0