Prediction of angiographic vasospasm after aneurysmal subarachnoid hemorrhage: Value of the hijdra sum scoring system

Background: Vasospasm is a major complication of aneurysmal subarachnoid hemorrhage (SAH) and affects clinical outcome. The ability to predict cerebral vasospasm after SAH would allow the neuro-intensivist to institute preemptive and more aggressive therapy. Methods: Social, clinical, and radiological information on adult SAH patients recently admitted to our hospital were reviewed. Univariate and multivariate statistical methods were used to examine the impact of patient demographics, clinical variables, and radiologic characteristics on the development of angiographic vasospasm. Results: One hundred and sixty three patients were identified (102 females, 63%). A total of 34 patients (21%) developed angiographic vasospasm. In univariate analysis, occurrence of cerebral vasospasm was associated with poor World Federation of Neurological Surgeons (WFNS 4-5, P = 0.003) and modified Fisher (MFS 3-4, P = 0.02) grades, elevated Hijdra sum score (HSS ≥ 23, P = 0.0001), female gender (P = 0.04), development of hydrocephalus (P = 0.01), and a history of tobacco use (P = 0.02). In multivariable analysis, only the HSS ≥ 23 (P = 0.01) and history of smoking (P = 0.02) predicted cerebral vasospasm. Combined history of smoking and HSS >23 had positive and negative predictive values of 37 and 88%, respectively, for prediction of cerebral vasospasm after aneurysmal hemorrhage. Conclusions: Hijdra sum score and a history of smoking are the strongest predictors of cerebral vasospasm on angiography. HSS is superior to the MFS as a radiologic grading tool to predict occurrence of angiographic vasospasm after aneurysmal subarachnoid hemorrhage.