Case Reports

Predictor scale of delayed cerebral ischemic in aneurysmal subarachnoid hemorrhage case series: what a radiologist should know

Made Widhi Asih , Ni Putu Popy Theresia Puspita

Made Widhi Asih
Staff of Radiology Department, Neuroradiology, Head and Neck Division, Faculty of Medicine Universitas Udayana – Sanglah Hospital Bali. Email:

Ni Putu Popy Theresia Puspita
Resident of Radiology Department, Faculty of Medicine, Universitas Udayana – Sanglah Hospital Bali
Online First: November 19, 2020 | Cite this Article
Asih, M., Puspita, N. 2020. Predictor scale of delayed cerebral ischemic in aneurysmal subarachnoid hemorrhage case series: what a radiologist should know. Indonesia Journal of Biomedical Science 14(2): 99-103. DOI:10.15562/ijbs.v14i2.272

Introduction: Delayed cerebral ischemic (DCI) was one of the most difficult and occurs in about 30% of patients with aneurysmal subarachnoid hemorrhage (aSAH) that could be predicted from computed tomography (CT) scans findings with the Fisher scale, modified Fisher scale, Claassen scale, and scale Hijdra score.

Case description: We reported 5 cases of aSAH at different locations with different DCI prediction scales. 4 of our 5 cases were treated for clipping aneurysm, but in the end, all of our cases developed DCI in the period of 10 to 14 days after aSAH from the mild form of hemiparesis to death.

Discussion: CT scan could predict DCI by some predictor scale. The first predictor scale was the Fisher scale, divided into four classes by assessing the amount of blood. Besides, the modified Fisher scale separated classes for patients with thick blood in the cisterna and IVH. The other scale was the Claassen Scale, which detailed the site of intraventricular blood-filled. Hijdra score is a broader alternative scale but requires more time, which assessed each cisterna amount of blood separately. The outcome was clinical DCI, defined by at least the occurrence of new focal neurological signs or a decrease in consciousness, with or without angiographic vasospasm or new infarct.

Conclusion: The high incidence of DCI leading to death in aSAH indicates the importance of accurate early diagnosis. Therefore, it is necessary to have an in-depth understanding of the essential imaging findings that include the Fisher scale, modified Fisher scale, Claassen scale, and Hijdra score to quickly and accurately guide patient management.


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