Shunt-dependency in symptomatic aneurysmal subarachnoid hemorrhage score

The shunt-dependency in symptomatic aneurysmal subarachnoid hemorrhage (SDASH) score is a harmonized score for the prediction of hydrocephalus requiring shunting after subarachnoid hemorrhage. The tool is employed in the acute phase to predict which patients will require shunting, rather than to assess them in late phase for candidacy ¹.

Score

The SDASH score is measured on a scale from 0 to 4 and includes select parameters from existing scales:

• Barrow Neurological Institute score
  • 1 point: ≥3
  • 0 points: <3
• Hunt and Hess grading system
  • 1 point: ≥4
  • 0 points: <4
• acute hydrocephalus (aHP)
  • 2 points: present
  • 0 points: absent

aHP is defined radiographically as the development of ventricle enlargement on the basis of the third ventricle width and periventricular low density on CT scan within 72 hours of the aneurysmal rupture, and clinically as mental deterioration, memory impairment, gait disturbance, and urinary incontinence ².

Interpretation

The probability of developing shunt-dependent hydrocephalus depending estimated by Diesing et al was as follows ¹:

• 0 points: 2.9%
• 1 point: 18.6%
• 2 points: 40.6%
• 3 points: 50%
• 4 points: 76.2%

The influence of additional factors such as the presence of a ventricular drain, increased daily CSF output, and/or aneurysm treatment strategy are currently unknown.