We hypothesized that early global cerebral edema (GCE) is associated with poor outcomes in patients with aneurysmal subarachnoid hemorrhage. In addition, we sought to validate the association of Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) at admission and outcomes in our cohort of patients admitted with aneurysmal subarachnoid hemorrhage (aSAH). 

Retrospective analysis of prospective cohort of 142 aSAH patients admitted to a tertiary care comprehensive stroke center over 5-year period. Admission CT scans were graded using SEBES by raters, who were blinded to clinical outcomes. Association between SEBES and delayed cerebral ischemia (DCI), discharge modified Rankin scale (mRS) and need for ventriculoperitoneal shunt (VPS) was investigated using non-parametric tests and regression modeling, respectively.

Average age of cohort (n=142) was 56.2±12.5 with 74.6% women. Fifty-two patients had WFNS grade 4-5 with ninety-eight patients had a modified-Fisher grade 3-4. Patients with severe GCE (SEBES 3-4) and mild GCE (SEBES 1-2) had higher incidences of DCI as compared to no GCE (SEBES 0) [Odds ratio, OR 5.4(95% CI 2.3-12.3), 2.8(95% CI 1.2-6.6) respectively, p=0.0002]. Similarly, mRS >2 was more prevalent among those with mild GCE [OR 5.1(95% CI 1.8-14.9), p=0.003] and severe GCE [OR 3.4(95%CI 1.4-8.3), p=0.006]. Additionally, both mild and severe GCE patients had higher needs for EVD placement & longterm shunt dependence [OR 5.4(95% CI 1.5-19.2) p=0.010, 3.9(95%CI 1.1-14.2) p=0.037 respectively].

We validated the SEBES in our patient cohort with aSAH. Our results are concordant with previously described association of GCE and poor outcomes. Additionally in our study, GCE at admission was associated with shunt dependence.