Characteristics of Patients Without Neuropsychological Deficits Following Aneurysmal Subarachnoid Haemorrhage

Stienen, Martin N.; Weisshaupt, Rahel; Fandiño, Javier; Hildebrandt, Gerhard; Studerus-Germann, Aline; Schatlo, Bawarjan

doi:10.1007/978-3-319-04981-6_21

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…The presence of intraparenchymal or intraventricular blood clots on initial CT imaging was associated with moderate impairment of at least two domains of the NAB-S at 12 months in our study. This is well in line with the results of previous studies indicating a relationship between the initial Fisher score and neuropsychological deficits and highlights the importance of blood location and clot size for neuropsychological outcome [31][32][33][34][35]. This might be due to the relation of Fisher grade and development of delayed cerebral ischemia; however, in our study, the development of DCI did not significantly correlate with more severe neuropsychological impairment indicating an important role of parenchymal lesions due to initial intraparenchymal hemorrhage and chronic hydrocephalus in the development of neuropsychological deficits within the first 12 months after the bleeding.…”

Section: Clinical Outcomesupporting

confidence: 91%

The neuropsychological assessment battery (NAB) is a valuable tool for evaluating neuropsychological outcome after aneurysmatic subarachnoid hemorrhage

et al. 2020

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Background Detecting and treating neuropsychological deficits after aneurysmatic subarachnoid hemorrhage (aSAH) play a key role in regaining independence; however, detecting deficits relevant to social and professional reintegration has been difficult and optimal timing of assessments remains unclear. Therefore, we evaluated the feasibility of administering the Neuropsychological Assessment Battery screening module (NAB-S) to patients with aSAH, assessed its value in predicting the ability to return to work and characterized clinical as well as neuropsychological recovery over the period of 24 months. Methods A total of 104 consecutive patients treated for aSAH were recruited. After acute treatment, follow up visits were conducted at 3, 12 and 24 months after the hemorrhage. NAB-S, Montreal Cognitive Assessment (MoCA) and physical examination were performed at each follow up visit. Results The NAB-S could be administered to 64.9, 75.9 and 88.9% of the patients at 3, 12 and 24 months, respectively. Moderate impairment of two or more neuropsychological domains (e.g speech, executive function, etc.) significantly correlated with inability to return to work at 12 and 24 months as well as poor outcome assessed by the extended Glasgow Outcome Scale (GOSE) at 3, 12 and 24 months. The number of patients with favorable outcomes significantly increased from 25.5% at discharge to 56.5 and 57.1% at 3 and 12 months, respectively, and further increased to 74.1% after 24 months. Conclusion The NAB-S can be administered to the majority of patients with aSAH and can effectively detect clinically relevant neuropsychological deficits. Clinical recovery after aSAH continues for at least 24 months after the hemorrhage which should be considered in the design of future clinical trials.

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Section: Clinical Outcomesupporting

confidence: 91%

The neuropsychological assessment battery (NAB) is a valuable tool for evaluating neuropsychological outcome after aneurysmatic subarachnoid hemorrhage

et al. 2020

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“…Of the 81 abstracts reviewed, 62 were excluded for failing to meet our inclusion criteria. After fully reviewing the remaining 19 studies, 6 were excluded for not reporting treatment group comparisons of neuropsychological tests, 26,27,32 not including both clipped and coiled patients, 1 or only providing pretreatment neuropsychological test data. 30 Thirteen studies were included in our systematic review, all cohort desig ns.…”

Section: Literature Searchmentioning

confidence: 99%

Neuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: a systematic review and meta-analysis

Egeto

Macdonald

Ornstein

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Subarachnoid hemorrhage (SAH) is treated with either surgical clipping or endovascular coiling, though the latter is the preferred treatment method given its more favorable functional outcomes. However, neuropsychological functioning after treatment is rarely taken into account. In this meta-analysis, the authors synthesized relevant data from the literature and compared neuropsychological functioning in patients after coiling and clipping of SAH. They hypothesized that the coiled patients would outperform the clipped patients; that group differences would be greater with higher posterior circulation rupture rates, in older patients, and in more recent publications; that group differences would be smaller with greater rates of middle cerebral artery (MCA) rupture; and that anterior communicating artery (ACoA) rupture rates would not influence effect sizes. METHODS The MEDLINE, Embase, and PsycINFO databases were searched for clinical studies that compared neuropsychological functioning after either endovascular coiling or surgical clipping for SAH. Hedge's g and 95% confidence intervals were calculated using random effects models. Patients who had undergone coiling or clipping were compared on test performance in 8 neuropsychological domains: executive functions, language, attention/processing speed, verbal memory, visual memory, spatial memory, visuospatial functions, and intelligence. Patients were also compared with healthy controls, and meta-regressions were used to explore the relation between effect sizes and publication year, delay between treatment and neuropsychological testing, mean patient age, and rates of posterior circulation, ACoA, and MCA ruptures. RESULTS Thirteen studies with 396 clipped cases, 314 coiled cases, and 169 healthy controls were included in the study. The coil-treated patients outperformed the clip-treated patients on executive function (g = 0.17, 95% CI 0.08-0.25) and language tests (g = 0.23, 95% CI 0.07-0.39), and all patients were impaired relative to healthy controls (g ranged from -0.93 to -0.29). Coiled patients outperformed clipped patients to a greater degree in more recent publications, over longer posttreatment testing delays, and among older patients. Higher rates of posterior circulation and MCA aneurysms were associated with smaller group differences, while ACoA rupture rates did not influence effect sizes. CONCLUSIONS Coiling of SAH may promote superior neuropsychological functioning under certain circumstances and could have applications for the specialized care of SAH patients.

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“…The neurologic status after treatment included the assessment of GCS, focal neurologic deficits, and, if possible, a neuropsychological evaluation. 23,24…”

Section: Assessment Of Rebleeding Treatment and Follow-upmentioning

confidence: 99%

“…When cerebral vasospasm occurred, standard therapy with hypertension and chemical angioplasty with nimodipine was performed according to our institution's protocol. 20,23 Despite maximal therapy, nine patients developed permanent ischemia and permanent neurologic deficits. Of the 10 patients with severe vasospasm, 5 survivors developed delayed cerebral ischemic deficits and 5 patients died.…”

Section: Treatmentmentioning

confidence: 99%

Outcome after In-Hospital Rebleeding of Rupture of Intracranial Aneurysms

Kienzler

Marbacher

Remonda

et al. 2016

J Neurol Surg A Cent Eur Neurosurg

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Background After initial subarachnoidal hemorrhage (SAH), due to an intracranial aneurysm, rebleeding is known as a factor influencing the devastating outcome. This complication has been reported to occur in $ 4% of the patients admitted with aneurysmal SAH. Moreover, ultra-early rebleeding within the first 24 hours might occur in 9 to 17% of the cases (40-87% appearing in the first 6 hours). Risk factors influencing this situation include increasing aneurysm size, deterioration of neurologic deficits, angiography within 3 hours of bleeding, sentinel symptoms, and the loss of consciousness at initial bleeding. The aim of this retrospective study was to assess factors and potential risk factors related to rebleeding, specifically the interval from initial SAH to rebleeding. Material and Methods From a consecutive series of 243 patients who experienced aneurysmal SAH, we identified 28 patients (11.5%; 12 men, 16 women; mean age: 58 AE 10 years) who developed in-hospital rebleeding during this 49-month study (2009)(2010)(2011)(2012)(2013). Demographic, radiologic, and clinical characteristics including hemodynamic parameters were analyzed. Results Rebleeding was fatal in 20 of the 28 patients (71%) and caused severe neurologic deficits (Glasgow Outcome Scale: 3; modified Rankin Scale: 5) in 3 (29%) of the remaining 8 survivors. Rebleeding occurred within the first 4 hours in 15 patients (54%) within 7, 24, and 48 hours in 17 (61%), 6 (21%), and 1 (4%) patient, respectively. In this series, the medium arterial blood pressure was 98 AE 11 mm Hg at arrival at the emergency department, 88 AE 10 mm Hg before rebleeding, and it dramatically increased to 124 AE 22 mm Hg at rebleeding. For the patients with rebleeding after aneurysmal SAH, initial sentinel headache (79%) and loss of consciousness (68%) were the common presenting symptoms. The World Federation of Neurological Societies grade was documented on admission as follows: 1-3 (n ¼ 14 [50%]); 4-5 (n ¼ 14 [50%]). A Fisher grade 4 was documented in 82% of the cases on the initial computed tomography (CT) scan. Overall, 42% of the cases underwent endovascular (n ¼ 6) or microsurgical occlusion of the aneurysm (n ¼ 6). The rest of the patients (n ¼ 16, 58%) did not underwent occlusion of the aneurysm because of poor clinical status. Digital substraction angiography was performed in 61% of the cases.

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Characteristics of Patients Without Neuropsychological Deficits Following Aneurysmal Subarachnoid Haemorrhage

Abstract: Patients without NPD after aSAH are likely to present with mild admission scores, develop neither chronic hydrocephalus nor DCI. In this series the aneurysm occlusion modality did not influence the cognitive outcome.

Cited by 8 publications

References 12 publications

The neuropsychological assessment battery (NAB) is a valuable tool for evaluating neuropsychological outcome after aneurysmatic subarachnoid hemorrhage

The neuropsychological assessment battery (NAB) is a valuable tool for evaluating neuropsychological outcome after aneurysmatic subarachnoid hemorrhage

Neuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: a systematic review and meta-analysis

Outcome after In-Hospital Rebleeding of Rupture of Intracranial Aneurysms

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