Objective:To describe short-term and 5-year rates of mortality and poor outcome in patients with spontaneous aneurysmal subarachnoid hemorrhage (aSAH) who received repair treatment.Methods:In this prospective observational study, mortality and poor outcome (modified Rankin Scale 3-6) were analyzed in 311 patients with aSAH at 3-month, 1-year, and 5-year follow-up. Sensitivity analysis was performed according to treatment modality. In-hospital and 5-year complications were analyzed.Results:Of 476 consecutive patients with spontaneous subarachnoid hemorrhage, 347 patients (72.9%) had aSAH. Of these, 311 (89.6%) were treated (242 endovascular, 69 neurosurgical), with a mean follow-up of 43.4 months (range, 1 to 145). Three-month, 1-year, and 5-year mortality was 18.4%, 22.9%, and 29.0%, and poor outcome was observed in 42.3%, 36.0%, and 36.0%, respectively. Adjusted poor outcome was lower in endovascular than in neurosurgical treatment at 3 months, with an absolute difference of 15.8%, and at 1 year, with an absolute difference of 15.9%. In both groups, Number Needed to Treat was 6.3. Odds ratios (OR) were 0.36 [95%CI 0.18-0.74] for endovascular and 0.40 [95%CI 0.20-0.81] for neurosurgical treatment. Complications did not differ between the two procedures. However, mechanical ventilation was less frequent with the endovascular technique (OR=0.67 [95%CI 0.54-0.84)].Conclusions:Patients with aSAH treated according to current guidelines had a short-term mortality of 18.4% and 5-year mortality of 29%. The majority (64.0%) of patients remained alive without disabilities at 5-year follow-up. Patients prioritized to endovascular treatment had better outcomes than those referred to neurosurgery because endovascular coiling was not feasible.
Background
Up to 20% of the cases of anorexia nervosa (AN) are chronic and treatment‐resistant. Recently, the efficacy of deep brain stimulation (DBS) for severe cases of AN has been explored, with studies showing an improvement in body mass index and other psychiatric outcomes. While the effects of DBS on cognitive domains have been studied in patients with other neurological and psychiatric conditions so far, no evidence has been gathered in AN.
Methods
Eight patients with severe, chronic, treatment‐resistant AN received DBS either to the nucleus accumbens (NAcc) or subcallosal cingulate (SCC; four subjects on each target). A comprehensive battery of neuropsychological and clinical outcomes was used before and 6‐month after surgery.
Findings
Although Body Mass Index (BMI) did not normalise, statistically significant improvements in BMI, quality of life, and performance on cognitive flexibility were observed after 6 months of DBS. Changes in BMI were related to a decrease in depressive symptoms and an improvement in memory functioning.
Interpretation
These findings, although preliminary, support the use of DBS in AN, pointing to its safety, even for cognitive functioning; improvements of cognitive flexibility are reported. DBS seems to exert changes on cognition and mood that accompany BMI increments. Further studies are needed better to determine the impact of DBS on cognitive functions.
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