Tsoma I. Clinical and diagnostic predictors of early and late outcome after nontraumatic subarachnoid hemorrhage

The dissertation is devoted to searching of diagnostic criteria, identification of prognostic factors of nontraumatic subarachnoid hemorrhage outcomes and patients` medical care standards improvement based on studying of clinical characteristics, laboratory and instrumental indicators and neuroimaging differences of SAH. We have found that the combination of several complications of SAH in one patient increases the risk of death in acute period. The presence of intracerebral hematoma on initial CT and symptomatic vasospasm were associated with an increased risk of poor outcome, while a repeated rupture of aneurysm was one of the main factors of the early mortality. It was found that serum glucose > 7,0 mmol/L (r = 0,40; р < 0,001) and leukocytosis > 10,0 · 10 * 9/L (r = 0,35; p = 0,01), may be the predictors of the poor prognosis. It was established that epileptic seizure in SAH onset is a predictor of worse prognosis (r = 0,36; p = 0,001). A combined patient assessment scale (CPAS) has been developed. Presence of epileptic seizure in SAH onset was considered in this scale. CPAS is an effective tool for assessing SAH prognosis. New algorithm of onset epileptic seizure treatment was proposed by prescribing a tablet form of levetiracetam at a dose of 2000-3000 mg per day without a titration period and gradual dose reduction after surgery (microsurgical / endovascular) aneurysm. The method is used in addition to the standard patient management. An approach of treatment effectiveness evaluation has been considered by assessing the quality of life for patients in remote period of SAH.