J Neurol Surg A Cent Eur Neurosurg 2015; 76 - A044
DOI: 10.1055/s-0035-1566363

Modified Glasgow Coma Scale Score as an Early Indicator of Cerebral Vasospasm in Patients with Aneurysmal Subarachnoid Hemorrhage

Đula Đilvesi 1, P. Vuleković 1, T. Cigić 1, V. Papić 1, N. Krajčinović 1, I. Horvat 1, M. Karan 1, B. Jelača 1, A. Azaševac 1, J. Golubović 1
  • 1Clinical Center of Vojvodina, Clinic of Neurosurgery, Novi Sad, Serbia

Introduction Cerebral vasospasm (CV) is a delayed narrowing of cerebral arteries, occurring 4 to 14 days after subarachnoid hemorrhage (SAH). CV is a possible cause of delayed deterioration of patients after aneurysmal SAH (aSAH). Timely diagnostics and therapy of CV could reduce the morbidity and mortality after ruptured intracranial aneurysm (IA). Important diagnostic tool for the early detection of CV in conscious patients is neurological examination. The modified Glasgow Coma Scale score (mGCS) is derived from the Glasgow Coma Scale score (GCS) assessment of eye opening, verbal, and motor response. The mGCS score is calculated as the sum of the eye-opening response, the verbal response, and the worst motor response.

Aim The aim of this study is to determine the correlation of mGCS and CV in patients with aSAH.

Material and Methods The research was a clinical, prospective, and included a total number of 50 patients hospitalized due to aSAH. In all patients, brain CT and CTA were made on admission and on ninth day, or earlier in the case neurological worsening. In all patients, GCS, mGCS, and deterioration of two points per modified Glasgow Coma Scale score (DmGCS ≥ 2) were recorded every 6 hours. The extent of angiographic vasospasm was determined by measurement of contrast in arterial blood vessels at admission and control CTA images. The degree of narrowing of the arteries diameter of 5 to 33% was classified as mild vasospasm, 34 to 66% as moderate vasospasm, and the narrowing degree of 67 to 100% as severe vasospasm.

Results In 15 patients (30%), DmGCS ≥ 2 occurred during the period of 15 days after aSAH, with respect to the previous mGCS monitoring. In six patients, DmGSC ≥ 2 repeatedly appeared. DmGCS ≥ 2 was first recorded on the sixth day after rupture of IA. The results showed a statistically significant positive correlation between the intensity of CV and DmGCS ≥ 2 for the period of 15 days after rupture of IA (ρ = 0.902, p < 0.01).

Conclusion DmGCS ≥ 2 strongly indicate the occurrence of CV. Regular monitoring of mGCS in patients after aSAH could lead to the early diagnosis of CV.

Keywords intracranial aneurysms; subarachnoid hemorrhage; cerebral vasospasm