Which Neuropsychological Deficits Are Hidden behind a Good Outcome (Glasgow = I) after Aneurysmal Subarachnoid Hemorrhage?

Abstract

A series of 31 patients with good neurological 6-month outcomes (Glasgow Outcome Scale = I) was examined with a battery of cognitive tests 1 to 5 years after aneurysmal subarachnoid hemorrhage (SAH) and early operation. The results showed a marked disability in 28 to 62% of these patients in the subtests of a complex choice reaction task. Short-term memory was impaired in 53% of the patients neuropsychologically examined, whereas 21% of them had a reduced long-term memory. Concentration was impaired in 7 to 16% of the SAH patients. Also, 10% of the patients rated Glasgow Outcome Scale = I had an indication for an aphasic language disturbance. Multivariate analysis proved significant harmful effects of the severity of the bleeding seen on computed tomographic scan (Fisher scale) on information processing and word-finding capacity. Patients who were older at the time of the SAH were significantly more disturbed in concentration, short-term memory, and information-processing capacity at follow-up. It can be concluded from these results that a good neurological outcome (Glasgow Outcome Scale = I) does not exclude persisting neuropsychological deficits. Therefore, the value of the clinical use of the Glasgow Outcome Scale is limited. As a consequence, a differentiated neuropsychological examination is proposed to evaluate the exact outcome of SAH patients.

Cognitive Assessment in Chinese Patients with Aneurysmal Subarachnoid Hemorrhage

“…Ljunggren et al even indicated in their sample of 40 patients with GOS = I significant deficits in 84% because they counted all patients with at least one deficit [16]. In nearly all studies, SAH patients were especially impaired in functions that are related to cognitive speed, concentration capacity, and memory function without a reduction of general intelligence or global intellectual functions [11]. Our result indicated that deficits of attention, executive function, and memory are prominent in SAH patients.…”

“…The frequency of cognitive deficits ranged from 7 to 84%, depending on the cognitive function tested. Hutter and Gilsbach found, in a sample of 31 SAH patients with a good 6-month outcome (Glasgow Outcome Scale = I), 54% with three or more cognitive deficits [11]. Bornstein [17].…”

“…Cognitive deficits were identified by comparing the test scores of the patients with published age-adjusted test norms, which represent the distribution of test scores one would find in the general population [11]. A cognitive deficit was defined as a value two standard deviations or more below the mean of normal controls in Arithmetic, Digit span, Digit symbol, Picture completion, and Visual Reproduction.…”

“…Cognitive deficits in these patients can interfere with return to work and social re-integration. The Glasgow Outcome Scale (GOS), the method frequently used for evaluating the outcome of SAH patients [13], is not sensitive to the cognitive deficits of these patients [11]. Thus, evaluation of cognitive function is likely to provide a sensitive measurement to identify possible differences in outcome to due to variations in operative techniques or perioperative care [9].…”

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

“…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…”