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We frequently experience grade improvement of poor-grade patients with subarachnoid hemorrhage (SAH) in the acute stage. In this study we evaluated the involvement of the presence or absence of the light reflex in the grade improvement. We retrospectively analyzed 109 poor-grade patients on admission without massive hematoma or prominent hydrocephalus. All patients were admitted within 6 hours after SAH onset with a poor Hunt & Kosnik grade (IV and V). In Grade IV patients no one revealed bilateral absence of the light reflex. Grade V patients were divided into 2 subgroups. Grade Va patients are assumed to have at least unilateral presence of the light reflex, and Grade Vb patients are assumed to have bilateral absence of the reflex. At the time of admission, 28 patients were Grade IV, 39 were Grade Va and 42 Grade Vb, respectively. Grade improvement in the acute stage was observed in 22 Grade IV (79%), 25 Grade Va (64%) and 2 Grade Vb (5%) patients. Forty five patients out of these 49 (92%) improved within 24 hours after admission. The grade improvement ratios in Grade IV and Va were statistically insignificant. The improvement ratio in Grade Vb was significantly lower than the other grades. After grade improvement, 22 Grade IV, 25 Grade Va and 2 Grade Vb patients underwent radical surgery, and favorable outcomes were obtained in 28 patients. The remaining 60 patients did not improve and the outcome was unfavorable. In Grade V patients with presence of the light reflex, grade improvement in the acute stage can be expected to be the same as that for Grade IV patients. The absence of the light reflex in poor-grade patients is a significant predictor of poor outcome.

Grade Improvement of Poor-grade Patients with Subarachnoid Hemorrhage in the Acute Stage: Involvement of the Light Reflex