Summary
Background. The neurological grade of poor-grade subarachnoid haemorrhage (SAH) often changes soon after the patient is admitted to the hospital. It is important to closely monitor for such changes within a short period of time after admission; however, there are other problems that can occur during this time such as rebleeding. The aim of this study was to evaluate the relationship between admission blood glucose levels (ABGL) and early change of neurological grade after admission in patients with poor-grade SAH.
Methods. Forty-six patients with poor-grade SAH (Hunt & Kosnik Grade IV or V), who were admitted within 3 hrs after SAH onset, and who did not have haematomas causing mass effect, or a history of diabetes mellitus, were included in the study. Patients were pretreated to control blood pressure and intracranial pressure, and they were monitored for early change of grade after admission. Blood glucose level was measured at the time of admission.
Findings. Spontaneous grade improvement was observed in 9 of 17 Grade IV patients and 9 of 29 Grade V patients. The ABGL of the patients with grade improvement were significantly lower than the ABGL of the patients who did not improve or who got worse. ABGL were lower than 180 mg/dl in 15 of 18 patients who showed grade improvement.
Conclusions. Our results showed that there was a relationship between ABGL and neurological grade changes which were observed after admission in patients with poor-grade SAH. These results suggest that ABGL might be a useful parameter for making therapeutic decisions.
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References
O Alberti R Becker L Benes T Wallenfang H Bertalanffy (2000) ArticleTitleInitial hyperglycemia as an indicator of severity of the ictus in poor-grade patients with spontaneous subarachnoid hemorrhage Clin Neurol Neurosurg 102 78–83 Occurrence Handle10817893 Occurrence Handle1:STN:280:DC%2BD3cvgtlWrtA%3D%3D Occurrence Handle10.1016/S0303-8467(00)00067-6
CR Benedict AB Loach (1978) ArticleTitleSympathetic nervous system activity in patients with subarachnoid hemorrhage Stroke 9 237–244 Occurrence Handle644621 Occurrence Handle1:STN:280:DyaE1c7mtVGgsg%3D%3D
K Berek S Kiechl B Pfausler A Auckenthaler E Schmutzhard (1992) ArticleTitlePrognostic indices in subarachnoid haemorrhage Lancet 339 68 Occurrence Handle1346000 Occurrence Handle1:STN:280:DyaK387gs12itg%3D%3D Occurrence Handle10.1016/0140-6736(92)90202-E
VL Chiang EB Claus IA Awad (2000) ArticleTitleToward more rational prediction of outcome in patients with high-grade subarachnoid hemorrhage Neurosurgery 46 28–36 Occurrence Handle10626932 Occurrence Handle1:STN:280:DC%2BD3c%2FptVemug%3D%3D Occurrence Handle10.1097/00006123-200001000-00006
J Claassen A Vu KT Kreiter RG Kowalski EY Du N Ostapkovich BF Fitzsimmons ES Connolly A Mayer (2004) ArticleTitleEffect of acute physiologic derangements on outcome after subarachnoid hemorrhage Crit Care Med 32 832–838 Occurrence Handle15090970 Occurrence Handle10.1097/01.CCM.0000114830.48833.8A
R Fogelholm K Murros A Rissanen S Avikainen (2005) ArticleTitleAdmission blood glucose and short term survival in primary intracerebral haemorrhage: a population based study J Neurol Neurosurg Psychiatry 76 349–353 Occurrence Handle15716524 Occurrence Handle1:STN:280:DC%2BD2M%2Fos1yruw%3D%3D Occurrence Handle10.1136/jnnp.2003.034819
WE Hunt EJ Kosnik (1974) ArticleTitleTiming and perioperative care in intracranial aneurysm surgery Clin Neurosurg 21 79–89 Occurrence Handle4608645 Occurrence Handle1:STN:280:DyaE2M%2FivFSjsQ%3D%3D
S Juvela J Siironen J Kuhmonen (2005) ArticleTitleHyperglycemia, excess weight, and history of hypertension as risk factors for poor outcome and cerebral infarction after aneurysmal subarachnoid hemorrhage J Neurosurg 102 998–1003 Occurrence Handle16028757 Occurrence Handle10.3171/jns.2005.102.6.0998
G Lanzino NF Kassell T Germanson L Truskowski W Alves (1993) ArticleTitlePlasma glucose levels and outcome after aneurysmal subarachnoid hemorrhage J Neurosurg 79 885–891 Occurrence Handle8246057 Occurrence Handle1:STN:280:DyaK2c%2FmsF2jtQ%3D%3D Occurrence Handle10.3171/jns.1993.79.6.0885
PD Le Roux JP Elliot DW Newell MS Grady HR Winn (1996) ArticleTitlePredicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases J Neurosurg 85 39–49 Occurrence Handle8683281 Occurrence Handle1:STN:280:DyaK283otF2gsA%3D%3D
SM Dorhout Mees GW van Dijk A Algra DR Kempink GJ Rinkel (2003) ArticleTitleGlucose levels and outcome after subarachnoid hemorrhage Neurology 61 1132–1133 Occurrence Handle14581680 Occurrence Handle1:STN:280:DC%2BD3srgsVCjsA%3D%3D
T Sasaki M Sato M Oinuma J Sakuma K Suzuki M Matsumoto N Kodama (2004) ArticleTitleManagement of poor-grade patients with aneurysmal subarachnoid hemorrhage in the acute stage: importance of close monitoring for neurological grade changes Surg Neurol 62 531–537 Occurrence Handle15576122 Occurrence Handle10.1016/j.surneu.2004.01.015
M Sato N Kodama T Sasaki K Suzuki M Sato M Matsumoto (2000) ArticleTitleAnalysis of patients with grade up of Hunt and Kosnik grade IV · V in the acute stage [in Japanese with English abstract] Surg Cereb Stroke 28 371–374
A Satoh (1998) ArticleTitleClinicopathological features and treatment of severely ill patients with a subarachnoid hemorrhage [in Japanese with English abstract] Jpn J Neurosurg 7 24–31
M Suzuki Y Otawara M Doi K Ogasawara A Ogawa (2000) ArticleTitleNeurological grades of patients with poor-grade subarachnoid hemorrhage improve after short-term pretreatment Neurosurgery 47 1098–1105 Occurrence Handle11063102 Occurrence Handle1:STN:280:DC%2BD3crgvFOmtg%3D%3D Occurrence Handle10.1097/00006123-200011000-00014
RU Weir ML Marcellus HM Do GK Steinberg MP Marks (2003) ArticleTitleAneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system AJNR Am J Neuroradiol 24 585–590 Occurrence Handle12695185
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Sato, M., Nakano, M., Asari, J. et al. Admission blood glucose levels and early change of neurological grade in poor-grade patients with aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 148, 623–626 (2006). https://doi.org/10.1007/s00701-005-0717-x
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DOI: https://doi.org/10.1007/s00701-005-0717-x