Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage

Rinkel, Gabriël J.E.; Algra, Ale

doi:10.1016/s1474-4422(11)70017-5

Cited by 400 publications

(289 citation statements)

References 72 publications

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“…Factors associated with unfavorable cognitive outcome include initial disease severity, the amount of subarachnoid blood, aneurysm location, and the occurrence of secondary complications such as delayed cerebral ischemia, and elevated intracranial pressure 2, 3. Cognitive and psychosocial long‐term deficits were also reported in SAH patients with “good clinical grade,” uneventful clinical course, and no evidence of structural brain damage 4, 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

Scherfler

Schiefecker

Delazer

et al. 2016

Ann Clin Transl Neurol

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Objective MRI parameters of iron concentration (R2*, transverse relaxation rate), microstructural integrity (mean diffusivity and fractional anisotropy), as well as gray and white matter volumes were analyzed in patients with subarachnoid hemorrhage (SAH) and uncomplicated clinical course to detect the evolution of brain tissue changes 3 weeks and 12 months after ictus.Methods MRI scans of 14 SAH patients (aneurysm of the anterior communicating artery, n = 5; no aneurysm n = 9) were compared with 14 age‐matched healthy control subjects. Statistical parametric mapping (SPM) was applied to objectively identify focal changes of MRI parameters throughout the entire brain and to correlate image parameters with neuropsychological measures.Results SPM localized significant bilateral increases in R2* signal within the white matter compartment of the temporal and parietal lobe and the cingulate gyrus (P < 0.001) which did not change significantly at 12 months. Significant gray matter volume reduction of the left insula and superior temporal gyrus (P < 0.001), as well as decreases in fractional anisotropy of the cingulate gyrus (P < 0.01) were also evident at 12 months. Significant correlations were found between fractional anisotropy signal alterations adjacent to the left middle and superior frontal gyrus and cognitive parameters of executive dysfunction (P < 0.001).InterpretationThe study indicates that iron is trapped predominantly throughout large portions of the white matter compartment in SAH patients at 12 months postbleeding. Increased disintegration of fiber tracts colocalizing with iron overload and correlating with lower executive function performance suggests that the white matter compartment is primarily susceptible toward long‐term damage in patients with good clinical grade SAH.

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Section: Introductionmentioning

confidence: 99%

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

Scherfler

Schiefecker

Delazer

et al. 2016

Ann Clin Transl Neurol

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“…During the chronic stage of the disease [12 months after aneurysmal subarachnoid hemorrhage (aSAH)], however, certain patients continue to exhibit cognitive dysfunctions, including diminishment in memory, attention, thinking and language cognitive function. A previous study on the long-term outcome of patients with aSAH demonstrated that there are numerous types of cognitive dysfunction in long-term survivors of aSAH following embolization therapy (3). In addition, a retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aSAH treatment.…”

Section: Introductionmentioning

confidence: 99%

Effect of thyroid hormone replacement therapy on cognition in long-term survivors of aneurysmal subarachnoid hemorrhage

Yang

Yin

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Aneurysmal subarachnoid hemorrhage (aSAH) is a recently identified risk factor for chronic hypothyroidism. Patients with hypothyroidism often exhibit cognitive dysfunction. The aim of the present study was to determine the effects of thyroid hormone replacement therapy on cognition in aSAH survivors with hypothyroidism. A study population of 135 patients was recruited and subjected to the Montreal Cognitive Assessment (MoCA) and Beck Depression Inventory. Among the study population, 52 patients exhibited cognitive dysfunction. Thyroid hormone levels were measured in these patients using an electrochemiluminescence immunoassay in order to elucidate possible deficits in the thyrotrophic hormonal axes, and hypothyroidism was confirmed in 31 patients. Among these 31 patients, 22 patients consented to be randomized into groups and were administered levothyroxine replacement or a placebo treatment for 3 months. The MoCA and Wechsler Adult Intelligence Scale-Chinese version (WAIS-RC) testing were performed prior to and following the replacement therapy or placebo treatments. All subjects completed the study with no negative side effects. After 8-12 weeks of oral levothyroxine administration, it was observed that the serum concentration of thyroid-stimulating hormone was restored to normal levels. Furthermore, neuropsychological test results improved following the replacement therapy. A significant improvement was observed in the MoCA scores of the replacement group following therapy, with the exception of the score for abstraction. Additionally, significant improvements in the WAIS-RC were observed in the replacement group, with the exceptions of the information comprehension and letter-number sequencing scores. Thus, the present study has demonstrated the partial normalization of cognitive impairments in patients with hypothyroidism following aSAH as a result of appropriate levothyroxine replacement therapy.

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“…The prognosis after SAH is determined by the initial insult as translated into clinical scales, such as the Hunt and Hess grade, but also by the occurrence of complications like vasospasm and delayed cerebral ischemia (DCI) [1,[3][4][5]. Besides these well-known factors, the occurrence of early brain injury at the time of haemorrhage is emerging as a leading cause of mortality [2].…”

Section: Background and Purposementioning

confidence: 99%

Evolution of diffusion tensor imaging parameters after acute subarachnoid haemorrhage: a prospective cohort study

et al. 2016

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Introduction Few studies assessed diffusion tensor imaging (DTI) changes in the acute phase of subarachnoid haemorrhage (SAH). We prospectively evaluated DTI parameters in the acute phase of SAH and 8-10 days after and analysed whether changes could be related to SAH severity or to the development of delayed cerebral ischemia (DCI). Methods Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) changes over time were assessed in a prospective cohort of patients with acute SAH. Two MRI studies were performed at <72 h (MRI-1) and 8-10 days (MRI-2). DTI parameters were recorded in 15 ROIs. Linear mixed regression models were used.

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Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage

Cited by 400 publications

References 72 publications

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

Effect of thyroid hormone replacement therapy on cognition in long-term survivors of aneurysmal subarachnoid hemorrhage

Evolution of diffusion tensor imaging parameters after acute subarachnoid haemorrhage: a prospective cohort study

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