Subarachnoid haemorrhage — diagnosis, grading and complications

Grading. Admission clinical condition is described with the Hunt and Hess and WFNS scales. The modified Fisher scale predicts symptomatic vasospasm — odds ratio 2.2 for grade 4 versus grade 0-1.^[1][2] LP when CT is negative. CT sensitivity overall was 92.9% (100% within 6 hours). If CSF is examined, spectrophotometry was 100% sensitive versus 73% for visual inspection.^[3][4] Nimodipine. Oral nimodipine 60 mg four-hourly reduced infarction (22 vs 33%) and poor outcome (20 vs 33%); in the Cochrane review oral nimodipine reduced poor outcome (RR 0.67) but intravenous nimodipine did not reach significance.^[5][6] DCI. Defined by cerebral infarction on imaging and functional outcome, with clinical deterioration secondary. Induced hypertension is unproven — the only RCT showed no benefit and more serious adverse events. Statins (STASH) did not help, and ESO recommends against statins, magnesium and endothelin antagonists.^[7][8][9][1]