Neurobehavioral Assessments of Cerebral Vasospasm - Animal Models of Acute Neurological Injuries: Injury and Mechanistic Assessments - page 541

Table 4
The Glasgow outcome Scale ( 5 )

Score Description

1 Death

2 Persistent vegetative state

3 Severe disability

4 Moderate disability

5 Good recovery

Ms. CD, age 45, right-handed African-American with Job's
syndrome, had a mild subarachnoid hemorrhage (SAH; Fischer's
grade 2; Hunt and Hess grade 2) from a right internal carotid
artery (ICA) aneurysm. Cerebral arteriography confi rmed the
presence of a “mirror” aneurysm on the left ICA bifurcations.
On the fourth day following SAH, the neck of the ruptured aneu-
rysm was successfully clipped. Postoperatively, the patient transiently
experienced right-sided hemiparesis attributed to a mild vasospasm
of the left ICA, but she was discharged without neurological defi -
cits on postoperative day 6. One month later, the aneurysm of the
contralateral ICA bifurcation was electively clipped and a postop-
erative arteriogram confi rmed complete occlusion of both aneu-
rysms. As in the previously presented case, her GOS was 5 at the
6-month and 1-year follow-up visits. However, she struggled at
work having memory and task-solving diffi culties that were associ-
ated with anxiety and depression, both of which progressed to the
point that she quit her job and went on disability.
These two patients, despite sharing the same diagnosis, corre-
sponding severity of disease, and adequate and generally similar
treatment but with obviously different outcomes, illustrate several
points that are addressed in this chapter.

2. Assessment
of Patient After
Intracranial
Aneurysm Repair

The initial issue is outcome assessment. Since 1938, when
Dr. Walter Dandy clipped the fi rst intracranial aneurysm ( 1 ), surgi-
cal and endovascular treatment has advanced dramatically because
of the contributions of many neurosurgeons, such as the “giants”
like Drs. G. Yasargil, V. Serbinienko, and G. Guglielmi, combined
with the advances of technology ( 2 ). Nevertheless, since that time,
intracranial aneurysm repair was, in the majority of cases, a lifesav-
ing procedure. As a result, the goal of such treatment focused on