Ulus Travma Acil Cerrahi Derg. 2006; 12(2): 107-114

Traumatic subarachnoid hemorrhage: a prospective study of 58 cases

Ali Ýhsan Ökten¹, Yurdal Gezercan¹, Rüçhan Ergün^2
1Department Of Neurosurgery Adana Numune Hospital, Adana, Turkey
²1st Department Of Neurosurgery Ssk Dýþkapý Training And Research Hospital, Ankara, Turkey

BACKGROUND: We evaluated the prognostic factors in traumatic subarachnoid hemorrhage (tSAH).
METHODS: This study was conducted with 58 patients (44 males, 14 females; mean age 39.2; range 17 to 79 years) with tSAH, between 2001 and 2003. The patients who were admitted to the hospital within in the first 6 hours of head injury were included, whereas patients with gun shot wounds, multiple injured patients and postoperative patients were excluded. Fifty-eight patients with tSAH were prospectively followed. The neurological status of the patients and the outcomes were evaluated using Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS), respectively and computed tomography (CT) examinations were done according to the grading criteria by Hijdra and Fisher.
RESULTS: The etiology of tSAH included traffic accidents (73%), falls (20%) and others (7%). The GCS scores of patients at admission were mild (9%), moderate (39%) and severe (52%). In the CT scans, the amount and distribution of bleeding was grade 1 (small SAH) in 21 patients, grade 2 (moderate SAH) in 17 patients, and grade 3 (extensive SAH) in 20 patients according to Hijdra grading system and according to Fisher's criteria. The thickness of blood layer was grade 1 (no blood) in 6 patients, grade 2 (bleeding layer less than 1 mm) in 21 patients, grade 3 (bleeding layer more than 1 mm) in 15 patients and grade 4 (ventricular bleeding) in 16 patients. Neurological outcomes of patients were favorable (good recovery or moderate disability) in 59%, and unfavorable (severe disability, persistent vegetative state or death) in 41% according to GOS.
CONCLUSION: We have found in our series that the prognosis was poor in patients with poor admission scores of GCS, cysternal or fissural hemorrhage, tSAH with cerebral contusion or acute subdural hematoma, higher than 13 points according to Hidjra's classification and patients of grade 3 or 4 in Fisher's criteria.

Keywords: Head injuries, subarachnoid hemorrhage/mortality/prognosis/radiography, survival rate; tomography, X-ray computed

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Travmatik subaraknoid kanamalar: 58 olguluk prospektif çalýþma

Ali Ýhsan Ökten¹, Yurdal Gezercan¹, Rüçhan Ergün^2
1S.B. Adana Numune Hastanesi Nöroflirürji Kliniði, Adana, Türkiye
²SSK Dýþkapý Eðitim ve Araþtýrma Hastanesi, 1. Nöroflirürji Kliniði, Ankara, Türkiye

AMAÇ: Bu çalýþmada travmatik subaraknoid kanamalarda (tSAK) prognozu etkileyen faktörlerin incelenmesi amaçlandý.
GEREÇ-YÖNTEM: Bu prospektif çalýþmaya 2001-2003 yýllarý arasýnda tedavi edilen 58 tSAK’lý hasta (44 erkek, 14 kadýn; ort. yaþ 39.2; daðýlým 17-79 yýl) alýndý. Çalýþmamýza travma sonrasý ilk altý saat içerisinde baþvuran hastalar dahil edildi; ateþli silah yaralanmalarý, multitravmalý ve ameliyat edilen hastalar çalýþma dýþýnda tutuldu. Hastalarýn nörolojik deðerlendirmesi Glasgow Koma Ölçeði’ne (GKÖ), sonuçlar Glasgow Sonuç Ölçeði’ne (GSÖ), bilgisayarlý tomografi (BT) incelemeleri ise Hijdra ve Fisher kriterlerine göre deðerlendirildi.
BULGULAR: Travmatik subaraknoid kanamalarýn etyolojisini en sýk trafik kazalarý (%73) ve düþme (%20) oluþturuyordu. Olgularýn hastaneye ilk geliþ durumlarý GKÖ’ne göre %9’u hafif, %39’u orta, %52’si þiddetli travma olarak deðerlendirildi. Hijdra derecelendirmesine göre BT’deki kan miktarý ve daðýlýmý: 21 hastada 1. derece (az miktarda kan), 17 hastada 2. derece (orta miktarda kan), 20 hastada 3. derece (aþýrý miktarda kan); Fisher kriterlerine göre pýhtý kalýnlýðý: 6 hastada 1. derece (kan yok), 21 hastada 2. derece (diffüz kanama), 15 hastada 3. derece (pýhtý kalýnlýðý 1 mm veya daha fazla kan), 16 hastada 4. derece (ventriküler kanama) olarak saptandý. GSÖ’ne göre hastalarýn %59’unda sonuçlar kabul edilebilir (tam iyileþme, orta derece sakatlýk), %41’inde ise kötü (ciddi derecede sakatlýk, vejetatif tablo, ölüm) bulundu.
SONUÇ: Çalýþmamýzda; giriþ GKÖ skoru düþük olanlarda, sistern ve fissürlerde kanamasý olanlarda, tSAK ile birlikte serebral kontüzyon veya akut subdural hematomu bulunanlarda, Hijdra kriterlerine göre aþýrý miktarda kan birikmesi olanlarda (13 puan ve üzeri) ve Fisher derecelendirmesine göre 3. ve 4. derecede olanlarda prognozun daha kötü olduðu sonucuna varýldý.

Anahtar Kelimeler: Kafa travmasý, subaraknoid kanama/mortalite/ prognoz/radyografi; saðkalým oraný; tomografi, X-ýþýný kompüterize

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