Attention Deficits After Aneurysmal Subarachnoid Hemorrhage Measured Using the Test of Variables of Attention

Abstract

Background and Purpose— The aim of this pilot study was to assess attention deficits in patients with aneurysmal subarachnoid hemorrhage using the test of variables of attention (TOVA). This is a computer-based continuous performance test providing objective measures of attention. We also compared the TOVA results with the attention and concentration domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment, 2 examiner-administrated neuropsychological instruments. Methods— Nineteen patients with moderate to good recovery (Glasgow outcome scale, 4–5) were assessed using the TOVA, Montgomery Åsberg Depression Rating Scale, and Montreal cognitive assessment. The measurements were done when the patients visited the hospital for a routine magnetic resonance imaging control of the aneurysm. Results— TOVA performance was pathological in 58%. The dominating pattern was a worsening of performance in the second half of the test, commonly a failing to react to correct stimuli. We found no correlation between TOVA and the performance in concentration and attention domains of Montgomery Åsberg Depression Rating Scale and Montreal cognitive assessment. Conclusions— Attention deficits, measured by the TOVA, were common after subarachnoid hemorrhage. This should be further studied to improve outcome.

S100B, NSE and MMP-9 fail to predict neurologic outcome while elevated S100B associates with milder initial clinical presentation after aneurysmal subarachnoid hemorrhage

“…Based on our findings it is not possible to evaluate whether elevation in these biomarkers is associated with brain injury causing these more subtle deficits. More sophisticated methods might be advantageous to detect such impairments [37,39]. Despite the relatively small sample size, our findings raise a significant doubt against the clinical utility of S100B, NSE, and MMP-9 as prognostic biomarkers after aSAH.…”

Symptoms and consequences of subarachnoid haemorrhage after 7 years

“…Attention deficits have been reported in previous follow‐up studies after SAH, as a common self‐reported cognitive complaint 3 months after SAH . Furthermore, attention deficits have been shown to be a common symptom (58%) demonstrated in a pilot study in a test of attention 7 months after SAH …”

Risk factors of acute coagulation dysfunction after aneurysmal subarachnoid hemorrhage

“…Although neurosurgical clipping following aSAH prevents aneurysm rerupture, neurological deficit, which was related to postoperative hemorrhagic or ischemic injury, was often detected after intracranial aneurysm clipping [3][4][5][6][7]. Previous studies indicated that coagulopathy was positively associated with the risk of hemorrhagic or ischemic brain injury after TBI [4,8,9,19].…”

“…Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 3-5% of strokes, which is serious harmful to human health for its high mortality and morbidity [1,2]. Although neurosurgical clipping following aSAH prevents rerupture of aneurysms, reduces the mortality and cognition, and improves the Glasgow Coma Scale (GCS), neurological deficits were detected after intracranial aneurysm clipping [3][4][5][6][7]. And it is known that postoperative hemorrhagic or ischemic injury caused by systematic coagulopathy was closely related to these complications [4,8,9].…”