***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Patients are classically at risk of delayed cerebral ischemia ( DCI ) after aneurysmal subarachnoid hemorrhage . We vali date d a grading scale — the VASO GRADE —for prediction of DCI . Methods — We used data of 3 phase II r and omized clinical trials and a single hospital series to assess the relationship between the VASO GRADE and DCI . The VASO GRADE derived from previously published risk charts and consists of 3 categories : VASO GRADE -Green ( modified Fisher scale 1 or 2 and World Federation of Neurosurgical Societies scale [ WFNS ] 1 or 2 ) ; VASO GRADE -Yellow ( modified Fisher 3 or 4 and WFNS 1–3 ) ; and VASO GRADE -Red ( WFNS 4 or 5 , irrespective of modified Fisher grade ) . The relation between the VASO GRADE and DCI was assessed by logistic regression models . The predictive accuracy of the VASO GRADE was assessed by receiver operating characteristics curve and calibration plots . Results — In a cohort of 746 patients , the VASO GRADE significantly predicted DCI ( P<0.001 ) . The VASO GRADE -Yellow had a tendency for increased risk for DCI ( odds ratio [ OR ] , 1.31 ; 95 % CI , 0.77–2.23 ) when compared with VASO GRADE -Green ; those with VASO GRADE -Red had a 3-fold higher risk of DCI ( OR , 3.19 ; 95 % CI , 2.07–4.50 ) . Studies were not a significant confounding factor between the VASO GRADE and DCI . The  VASO GRADE had an adequate discrimination for prediction of DCI ( area under the receiver operating characteristics curve=0.63 ) and good calibration . Conclusions — The VASO GRADE results vali date d previously published risk charts in a large and diverse sample of subarachnoid hemorrhage patients , which allows DCI risk stratification on presentation after subarachnoid hemorrhage . It could help to select patients at high risk of DCI , as well as st and ardize treatment protocol s and research studies Using logistic regression , we analyzed the predictive value of a number of entry variables with respect to the outcome variables delayed cerebral ischemia , rebleeding , and poor outcome ( death or severe disability ) in patients with aneurysmal subarachnoid hemorrhage . The entry variables were clinical condition on admission ( grade s on the Glasgow Coma Scale , Hunt and Hess system ) , the amount of subarachnoid and intraventricular blood and the presence of hydrocephalus on the admission computed tomogram , and antifibrinolytic treatment with tranexamic acid . We used data from a prospect ively studied population of 176 patients admitted within 72 hours after subarachnoid hemorrhage . The risk of delayed cerebral ischemia was best predicted by the amount of subarachnoid blood , intraventricular blood , and antifibrinolytic treatment  irrespective of clinical condition and hydrocephalus . The site of delayed cerebral ischemia was not related to the location of the subarachnoid hemorrhage . Antifibrinolytic treatment was the only entry variable ( negatively ) predicting the risk of rebleeding . Death or severe disability after 3 months was best predicted by the amount of subarachnoid blood and the initial clinical condition reflected by the grade on the Glasgow Coma Scale Introduction Subarachnoid hemorrhage ( SAH ) can trigger immune activation sufficient to induce the systemic inflammatory response syndrome ( SIRS ) . This may promote both extra-cerebral organ dysfunction and delayed cerebral ischemia , contributing to worse outcome . We ascertained the frequency and predictors of SIRS after spontaneous SAH , and determined whether degree of early systemic inflammation predicted the occurrence of vasospasm and clinical outcome . Methods Retrospective analysis of prospect ively collected data on 276 consecutive patients admitted to a neurosciences intensive care unit with acute , non-traumatic SAH between 2002 and 2005 . A daily SIRS score was derived by summing the number of variables meeting st and ard criteria ( HR > 90 , RR > 20 , Temperature > 38 ° C , or < 36 ° C , WBC count < 4,000 or > 12,000 ) . SIRS was considered present if two or more criteria were met , while SIRS burden over the first four days was calculated by averaging daily scores . Regression modeling was used to determine the relationship among SIRS burden ( after controlling for confounders including infection , surgery , and corticosteroid use ) , symptomatic vasospasm , and outcome , determined by hospital disposition . Results SIRS was present in over half the patients on admission and developed in 85 % within the first four days . Factors associated with SIRS included poor clinical grade , thick cisternal blood , larger aneurysm size , higher admission blood pressure , and surgery for aneurysm clipping . Higher SIRS burden was independently associated with death or discharge to nursing home ( OR 2.20/point , 95 % CI 1.27–3.81 ) . All of those developing clinical vasospasm had evidence of SIRS , with greater SIRS burden predicting increased risk for delayed ischemic neurological deficits ( OR 1.77/point , 95 % CI 1.12–2.80 ) . Conclusions Systemic inflammatory activation is common after SAH even in the absence of infection ; it is more frequent in those with more severe hemorrhage and in those who undergo surgical clipping . Higher burden of SIRS in the initial four days independently predicts symptomatic vasospasm and is associated with worse outcome OBJECTIVE The aim of this study was to investigate prospect ively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are , what the outcome is , how many of these patients have “ modern treatment”—that is , early obliteration of the aneurysm and treatment with calcium antagonists — what factors cause a delay in surgical or endovascular treatment , and what the estimated effect on outcome will be of improved treatment . METHODS A prospect i ve , observational cohort study of all patients with aneurysmal subarachnoid haemorrhage in the hospitals of a specified region in The Netherl and s. The condition on admission , diagnostic procedures , and treatments were recorded . If a patient had a clinical deterioration , the change in Glasgow coma score ( GCS ) , the presence of focal neurological signs , the results of additional investigations , and the final diagnosed cause of the deterioration were recorded . Clinical outcome was assessed with the Glasgow outcome scale ( GOS ) at 3 month follow up . In patients with poor outcome at follow up , the cause was diagnosed . RESULTS Of the 110 patients , 47 ( 43 % ) had a poor outcome . Cerebral ischaemia , 31 patients ( 28 % ) , was the most often occurring complication . Major causes of poor outcome were the effects of the initial haemorrhage and rebleeding in 34 % and 30 % of the patients with poor outcome respectively . Of all patients 102 ( 93 % ) were treated with calcium antagonists and 45 ( 41 % ) patients had early treatment to obliterate the aneurysm . The major causes of delay of treatment were a poor condition on admission or deterioration shortly after admission , in 31 % and 23 % respectively . CONCLUSIONS In two thirds of the patients with poor outcome the causes of poor outcome are the effects of the initial bleeding and rebleeding . Improved treatment of delayed or postoperative ischaemia will have only minor effects on the outcome of patients with subarachnoid haemorrhage Background The risk of delayed cerebral ischemia ( DCI ) after subarachnoid hemorrhage ( SAH ) is associated with large cerebral artery vasospasm , but vasospasm is not a strong predictor for DCI . Assessment of cerebral autoregulation with transcranial Doppler ( TCD ) may improve the prediction of DCI . The aim of this prospect i ve study was to assess the value of TCD-derived variables to be used alone or in combination for prediction of DCI . Methods We included consecutive patients with low- grade aneurysmal SAH within 4 days of aneurysm rupture . Cerebral autoregulation was evaluated using the moving correlation coefficient Mx calculated from spontaneous fluctuations of cerebral blood flow velocities and arterial blood pressure . Transcranial color-coded sonography was performed to assess large artery vasospasm . Results Thirty patients ( 19 women and 11 men ; mean age ± SD 44.7 ± 12.1 years ) were included . Twenty ( 66.7 % ) patients had vasospasm . DCI occurred in six ( 20 % ) patients after a median delay of 10 days ( range 8–13 days ) . Cerebral autoregulation was impaired at baseline and at day 7 and then returned to normal at day 14 . Neither cerebral autoregulation impairment nor large artery vasospasm alone was associated with DCI . In contrast , the combination of large artery vasospasm with worsening impairment of cerebral autoregulation from baseline to day 7 was significantly correlated to subsequent DCI ( p = 0.007 ) . Conclusions Early deterioration of cerebral autoregulation was strongly predictive of DCI in patients with large artery vasospasm after low- grade SAH . Our results suggest that consideration to both cerebral blood flow velocities and cerebral autoregulation may improve the prediction of DCI UNLABELLED The Fisher revised scale ( FRS ) presents an alternative for evaluating patients with subarachnoid hemorrhage ( SAH ) . In this study , we compared the prognosis of patients with SAH and vasospasms ( VSP ) . METHOD This was a prospect i ve study on patients with a diagnosis of aneurysmal SAH , 72 hours after the initial event . Sequential neurological examinations and Hunt and Hess ( HaH ) score were performed on the 1(st ) , 7(th ) and 14(th ) days . Transcranial Doppler was used to assess vasospasms . RESULTS Out of the 24 patients studied , ten ( 41.66 % ) presented a delayed neurological deficit , such as diminished consciousness , decreased HaH score or death . The single patient classified as FS-1 did not have any delayed neurological deficit , while such deficits evolved in one patient out of five with FS-2 ( 20 % ) ; two out of seven with FS-3 ( 28.57 % ) and seven out of 11 with FS-4 ( 63.63 % ) . CONCLUSION Level three of the FS and FRS seemed to be compatible with regard to predicting the likelihood of progression to severe VSP Background and Purpose — A single-center prospect i ve r and omized controlled trial has been conducted to determine if lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage reduces the prevalence of delayed ischemic neurological deficit and improves clinical outcome . Methods — Patients with World Federation of Neurological Surgeons Grade 1 to 3 aneurysmal subarachnoid hemorrhage and modified Fisher Grade s 2 , 3 , 4 , and 3 + 4 were r and omized to either the study group of st and ard therapy plus insertion of a lumbar drain or the control group of st and ard therapy alone .  The primary outcome measure was the prevalence of delayed ischemic neurological deficit . Results — Two hundred ten patients with aneurysmal subarachnoid hemorrhage ( 166 female , 44 male ; median age , 54 years ; interquartile range , 45–62 years ) were recruited into the control ( n=105 ) and study ( n=105 ) groups of the trial . World Federation of Neurological Surgeons grade was : 1 ( n=139 ) , 2 ( n=60 ) , and 3 ( n=11 ) ; Fisher grade was : 2 ( n=87 ) , 3 ( n=85 ) , and 4 ( n=38 ) . The prevalence of delayed ischemic neurological deficit was 35.2 % and 21.0 % in the control and study groups , respectively ( P=0.021 ) . The prevalence of a modified Rankin Scale score of 4 , 5 , or 6 at Day 10 and 6 months , respectively , was 62.5 % and 18.6 % in the control group and 44.8 % and 19.8 % in the study group ( P=0.009 and 0.83 , respectively ) . Conclusions — Lumbar drainage of cerebrospinal fluid after aneurysmal subarachnoid hemorrhage has been shown to reduce the prevalence of delayed ischemic neurological deficit and improve early clinical outcome but failed to improve outcome at 6 months after aneurysmal subarachnoid hemorrhage . Clinical Trial Registration — URL : www . clinical trials.gov . Unique identifier : NCT00842049 OBJECTIVE We developed a modification of the Fisher computed tomographic rating scale and compared it with the original Fisher scale to determine which scale best predicts symptomatic vasospasm after subarachnoid hemorrhage . METHODS We analyzed data from 1355 subarachnoid hemorrhage patients in the placebo arm of four r and omized , double-blind , placebo-controlled studies of tirilazad .  Modified Fisher computed tomographic grade s were calculated on the basis of the presence of cis 
    Output:
    
Conclusion The  Fisher scale , modified Fisher scale , and Hijdra sum score are all associated with clinical DCI .
The risk of DCI , however , does not increase with increasing Fisher grade as opposed to the modified Fisher scale .