The incidence and factors predicting long term neurological improvement and recovery of patients with poor-grade aneurysmal subarachnoid hemorrhage (SAH) are reported by Wilson et al in a cohort study of 88 poor-grade SAH patients from the Barrow Ruptured Aneurysm Trial (BRAT). The mean aggregate mRS scores at 6 months (3.31 ± 2.1), 12 months (3.28 ± 2.2), and 36 months (3.17 ± 2.3) improved significantly compared with the mean score at hospital discharge (4.33 ± 1.3, p < 0.001), but the 1-point reduction in mRS may not be clinically relevant in some patients. Between discharge and 6 months, 61% of patients improved on mRS. The incidence of improvement between 6–12 months and 12–36 months was almost 1 in 5 patients. The most important factors for improvement up to 6 months are: patients presenting in better clinical condition (grade IV versus grade V), absence of large (> 4cm) or eloquent strokes, and patients < 65 years old also show more improvement beyond 6 months. The absence of a large stroke on CT imaging strongly predicts improvement beyond 1 year.
Journal of Neurosurgery