Acta Neurochirurgica

, Volume 137, Issue 3–4, pp 146–150 | Cite as

Prognostic value of evoked potentials and clinical grading in primary subarachnoid haemorrhage

  • W. F. Haupt
  • C. Hojer
  • G. Pawlik
Clinical Articles


In a retrospective study of 64 patients suffering from primary subarachnoid haemorrhage (SAH), the clinical grading according to Hunt and Hess as well as the initial findings of brainstem auditory evoked potentials (BAEP) and median-nerve somatosensory potentials (SEP) were correlated with each other and with disease outcome to determine the prognostic value of evoked potential testing in comparison to the initial clinical grading according to Hunt and Hess.

All patients were treated in a neurological intensive care unit. Normal evoked potentials usually indicate a favourable course. Alterations of SEP and BAEP increase in parallel with the severity of clinical findings. Unilateral or bilateral loss of SEP or BAEP indicates a poor prognosis. Clinical and electrophysiological findings show a close correlation, but only BAEP provide prognostic information beyond Hunt/Hess grading.

In SAH patients, clinical grading was well as evoked potentials correlate significantly with outcome. Use of both clinical and EP rating improves prognostic accuracy.


Subarachnoid haemorrhage prognosis Hunt-Hess grades evoked potentials 


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  1. 1.
    Adams HP, Gordon DL (1991) Nonaneurysmal subarachnoid hemorrhage. Ann Neurol 29: 461–462CrossRefPubMedGoogle Scholar
  2. 2.
    Berlit P (1988) CT findings in subarachnoid hemorrhage (SAH). Neurochirurgia 31: 123–127PubMedGoogle Scholar
  3. 3.
    Dorsch NWC, Branston NM, Harris RJ, Bentivglio P, Symon L (1989) An experimental study of the effect of nimodipine in primate subarachnoid hemorrhage. Acta Neurochir (Wien) 99: 65–75CrossRefGoogle Scholar
  4. 4.
    Fox JE, Williams B (1984) Central conduction time following surgery for cerebral aneurysm. J Neurol Neurosurg Psychiatry 47: 873–875PubMedGoogle Scholar
  5. 5.
    Hacke W, Stöhr M, Diener HWC, Büttner U (1985) Empfehlungen zur Untersuchungsmethodik evozierter Potentiale in der Routinediagnostik. EEG-EMG 16: 162–164PubMedGoogle Scholar
  6. 6.
    Haupt WF, Hojer C (1991) Zur Prognose der Subarachnoidal-blutung: Zusammenhänge zwischen Hunt-Hess Graduierungen und Befunden evozierter Potentiale. In: Neundörfer B, Erbguth F (eds) Schwerpunkte neurologischer Intensivmedizin. Perimed, Nürnberg, pp 67–70Google Scholar
  7. 7.
    Hojer C, Haupt WF (1993) Zur prognostischen Wertigkeit von AEP- und SEP-Befunden bei Subarachnoidalblutungen. Neurochirurgia 36: 110–116PubMedGoogle Scholar
  8. 8.
    Hornyak M, Gilsbach J, Harders A (1991) Clinical significance of computed tomography in early aneurysm surgery. Neurochirurgia 34: 135–140PubMedGoogle Scholar
  9. 9.
    Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20PubMedGoogle Scholar
  10. 10.
    Kuyama H, Ladds A, Branston NM, Nitta M, Symon L (1984) An experimental study of acute subarachnoid hemorrhage in baboons: changes in cerebral blood volume, blood flow, electrical activity and water content. J Neurol Neurosurg Psychiatry 47: 354–364PubMedGoogle Scholar
  11. 11.
    Lienert GA (1986) Verteilungsfreie Methoden in der Biostatistik, Vol 1, 3rd Ed. Hain, Königstein/TaunusGoogle Scholar
  12. 12.
    Locksley HB (1966) Report on the cooperative study of intracranial aneurysms and subarachnoid hemorrhage: Section V, Part 2. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg 25: 219–239PubMedGoogle Scholar
  13. 13.
    Nornes H (1973) The role of intracranial pressure in the arrest of hemorrhage in the patients with ruptured intracranial aneurysm. J Neurosurg 39: 226–234PubMedGoogle Scholar
  14. 14.
    Nornes H (1978) Cerebral arterial flow dynamics during aneurysm hemorrhage. Acta Neurochir (Wien) 41: 39–48CrossRefGoogle Scholar
  15. 15.
    Nornes H, Magnaes B (1972) Intracranial pressure in patients with ruptured saccular aneurysm. J Neurosurg 36: 537–547PubMedGoogle Scholar
  16. 16.
    Nornes H, Wikeby P (1979) Results of microsurgical management of intracranial aneurysms. J Neurosurg 51: 608–614PubMedGoogle Scholar
  17. 17.
    Noterman J, Dewitte O, Baleriaux D, Brotchi J (1991) Les hémorragies sous-arachnoidiennes (H.S.A.) d'étiologie inconnue. A propos de 59 cas. Neurochirurgie 37: 383–387PubMedGoogle Scholar
  18. 18.
    Richards PG, Tsutsui T, Symon L, Jabre A, Rosenstein J, Redmond S (1986) Comparison of fast flow and initial slope index values for cerebral blood flow following subarachnoid hemorrhage. J Neurol Neurosurg Psychiatry 49: 431–434PubMedGoogle Scholar
  19. 19.
    Rinkel GJE, Wijdicks EFM, Hasan D, Kienstra GEM, Fanke CL, Hageman LM, Vermeulen M, van Gijn J (1991) Outcome in patients with subarachnoid hemorrhage and negative angiography according to pattern of hemorrhage on computed tomography. Lancet 338: 964–968CrossRefPubMedGoogle Scholar
  20. 20.
    Rinkel GJE, Wijdicks EFM, Vermeulen M, Hasan D, Brouwers PJAM, van Gijn J (1991) The clinical course of perimesencephalic nonaneurysmal subarachnoid hemorrhage. Ann Neurol 29: 463–468CrossRefPubMedGoogle Scholar
  21. 21.
    Rinkel GJE, Wijdicks EFM, Vermeulen M, Ramos LMP, Tanghe HLJ, Hasan D, Meiners LC, van Gijn J (1991) Nonaneurysmal perimesencephalic subarachnoid hemorrhage: CT and MR patterns that differ from aneurysmal rupture. Am J Neuroradiol 12: 829–834PubMedGoogle Scholar
  22. 22.
    Ronkainen A, Hernesniemi J (1992) Subarachnoid hemorrhage of unknown etiology. Acta Neurochir (Wien) 119: 29–34CrossRefGoogle Scholar
  23. 23.
    Rosenstein J, Wang AD, Symon L, Suzuki M (1985) Relationship between hemispheric cerebral blood flow, central conduction time, and clinical grade in aneurysmal subarachnoid hemorrhage. J Neurosurg 62: 25–30PubMedGoogle Scholar
  24. 24.
    Symon L, Hargadine J, Zawirski M, Branston N (1979) Central conduction time as an index of ischemia in subarachnoid hemorrhage. J Neurol Sci 44: 95–103CrossRefPubMedGoogle Scholar
  25. 25.
    Symon L, Wang AD, Costa e Silva IE, Gentili F (1984) Perioperative use of somatosensory evoked responses in aneurysma surgery. J Neurosurg 60: 269–275PubMedGoogle Scholar
  26. 26.
    Toole JF, Robinson MK, Mercuri M (1989) Primary subarachnoid hemorrhage. In: Toole JF (ed) Handbook of clinical neurology, Vol II (55): vascular diseases, Part III. Elsevier, Amsterdam, pp 1–40Google Scholar
  27. 27.
    Wang DA, Cone J, Symon L, Costa e Silva IE (1984) Somatosensory evoked potential monitoring during the management of aneurysmal SAH. J Neurosurg 60: 264–268PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • W. F. Haupt
    • 1
  • C. Hojer
    • 1
  • G. Pawlik
    • 1
  1. 1.Department of NeurologyUniversity of CologneCologneFederal Republic of Germany

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