scholarly journals Early brain injury and cognitive impairment after aneurysmal subarachnoid haemorrhage

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Matthew J. Rowland ◽  
Payashi Garry ◽  
Martyn Ezra ◽  
Rufus Corkill ◽  
Ian Baker ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Acute Phase ◽  
Early Brain Injury ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Healthy Controls ◽  
Good Grade ◽  
The Impact

AbstractThe first 72 h following aneurysm rupture play a key role in determining clinical and cognitive outcomes after subarachnoid haemorrhage (SAH). Yet, very little is known about the impact of so called “early brain injury” on patents with clinically good grade SAH (as defined as World Federation of Neurosurgeons Grade 1 and 2). 27 patients with good grade SAH underwent MRI scanning were prospectively recruited at three time-points after SAH: within the first 72 h (acute phase), at 5–10 days and at 3 months. Patients underwent additional, comprehensive cognitive assessment 3 months post-SAH. 27 paired healthy controls were also recruited for comparison. In the first 72 h post-SAH, patients had significantly higher global and regional brain volume than controls. This change was accompanied by restricted water diffusion in patients. Persisting abnormalities in the volume of the posterior cerebellum at 3 months post-SAH were present to those patients with worse cognitive outcome. When using this residual abnormal brain area as a region of interest in the acute-phase scans, we could predict with an accuracy of 84% (sensitivity 82%, specificity 86%) which patients would develop cognitive impairment 3 months later, despite initially appearing clinically indistinguishable from those making full recovery. In an exploratory sample of good clinical grade SAH patients compared to healthy controls, we identified a region of the posterior cerebellum for which acute changes on MRI were associated with cognitive impairment. Whilst further investigation will be required to confirm causality, use of this finding as a risk stratification biomarker is promising.

The impact of hypopituitarism on function and performance in subjects with recent history of traumatic brain injury and aneurysmal subarachnoid haemorrhage

Brain Injury ◽  
2009 ◽  
Vol 23 (7-8) ◽  
pp. 639-648 ◽  
Author(s):  
Lakshmi Srinivasan ◽  
Brian Roberts ◽  
Tamara Bushnik ◽  
Jeffrey Englander ◽  
David A. Spain ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Recent History ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
History Of ◽  
And Performance ◽  
The Impact

scholarly journals Relevance of Presenting Risks of Frailty, Sarcopaenia and Osteopaenia to Outcomes From Aneurysmal Subarachnoid Haemorrhage

2021 ◽  
Author(s):  
Jia Xu Lim ◽  
Yuan Guang Lim ◽  
A Aravin Kumar ◽  
Tien Meng Cheong ◽  
Julian Xinguang Han ◽  
...  
Keyword(s):  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Frailty Index ◽  
Acute Brain Injury ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Improvement Program ◽  
Modified Frailty Index ◽  
Neurological Surgery

Abstract IntroductionAneurysmal subarachnoid haemorrhage (aSAH) is a condition with significant morbidity and mortality. In the context of acute brain injury, frailty, sarcopaenia and osteopaenia have become increasing concerns. Multiple indices have been devised in various surgical specialties to predict outcome and guide management. In this study, we examined whether such markers have relevance towards outcomes from acute brain conditions, such as aSAH. MethodsAn observational study in a tertiary neurosurgical unit on 51 consecutive patients with ruptured aSAH was performed. We compared various frailty indices (modified frailty index 11, and 5, and the National Surgical Quality Improvement Program score [NSQIP]), temporalis (TMT) and zygoma thickness (markers of sarcopaenia and osteopaenia), against traditional markers (age, World Federation of Neurological Surgery and modified Fisher scale [MFS]) for aSAH outcomes. ResultsTMT was the best performing marker in our cohort with an AUC of 0.82, Somers’ D statistic of 0.63 and Tau statistic 0.25. Of the frailty scores, the NSQIP performed the best (AUC 0.69, Somer’s D 0.40, Tau 0.16), at levels comparable to traditional markers of aSAH, such as MFS (AUC 0.68, Somer’s D 0.43, Tau 0.17). After multivariate analysis, patients with TMT ≥5.5mm (defined as non-frail), were less likely to experience complications (OR 0.20 [0.06 – 0.069], p = 0.011), and had a larger proportion of favourable mRS on discharge (95.0% vs. 58.1%, p = 0.024) and at 3-months (95.0% vs. 64.5%, p = 0.048). However, the gap between unfavourable and favourable mRS was insignificant at the comparison of 1-year outcomes. ConclusionTMT, as a marker of sarcopaenia, correlated well with the presenting status, and outcomes of aSAH. Frailty, as defined by NSQIP, performed at levels equivalent to aSAH scores of clinical relevance, suggesting that, in patients presenting with acute brain injury, both non-neurological and neurological factors were complementary in the determination of eventual clinical outcomes. Further validation of these markers, in addition to exploration of other relevant frailty indices, may help to better prognosticate aSAH outcomes and allow for a precision medicine approach to decision making and optimization of best outcomes Trial registrationNot applicable

scholarly journals Outcome and rehabilitation of patients following aneurysmal subarachnoid haemorrhage

2017 ◽  
Vol 04 (04) ◽  
pp. S65-S75 ◽  
Author(s):  
Dhaval Shukla
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Subarachnoid Haemorrhage ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Clinical Grade ◽  
The Past ◽  
Main Determinants ◽  
Neuropsychological Impairments

AbstractAneurysmal subarachnoid haemorrhage (SAH) is a dreaded neurosurgical disorder. Although the mortality has been declining in the past three decades, the disability after SAH is still significant. The main determinants of outcome are age, clinical grade, amount of SAH and size of aneurysm. Both neurophysical deficits and neuropsychological impairments are determinants of functional outcome after SAH. Patients should be assessed using outcome measures for both traumatic brain injury and stroke. Early rehabilitation after SAH improves not only physical outcome but also cognitive and functional outcome.

scholarly journals Management of aneurysmal subarachnoid haemorrhage with intracerebral hematoma: Is there an indication for coiling first? Study of 44 cases

2015 ◽  
Vol 22 (1) ◽  
pp. 5-11
Author(s):  
Céline Salaud ◽  
Olivier Hamel ◽  
Tanguy Riem ◽  
Hubert Desal ◽  
Kevin Buffenoir
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Poor Prognosis ◽  
Intracerebral Hematoma ◽  
World Federation ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Aneurysm Clipping ◽  
Good Outcome ◽  
A Prospective Study ◽  
Aneurysm Coiling ◽  
Radiologic Characteristics

Background Aneurysmal subarachnoid haemorrhage (ASH) with intracerebral hematoma (ICH) has a poor prognosis. The treatment is to secure the aneurysm and do an ICH evacuation. Objective The aim of the study was to determine if aneurysm coiling followed by ICH evacuation is a viable alternative treatment compared to exclusive surgery, regardless of the clinical or paraclinical presentations. Methods A retrospective study was conducted between 2004 and 2014, which included 44 patients. The patients were divided up in four groups. Two were principal groups: The clipped group (aneurysm clipping with ICH evacuation) and the coiled group (aneurysm coiling, followed by ICH evacuation); and two were subgroups of the latter: Aneurysm coiling with ICH evacuation after 24 hours and ICH evacuation followed by aneurysm coiling. We studied the demographic and radiologic characteristics, and the 3-month outcome. Results We included 17 patients in the coiled group: The outcome was better for the patients with World Federation of Neurosurgery (WFNS) scores of 1, 2 and 3; compared to the patients with WFNS scores 4 and 5. We included 16 patients in the clipped group: The outcome was better, compared the coiled group, for those patients with WFNS scores 4 and 5. Six patients were treated with aneurysm coiling, followed by ICH evacuation after 24 hours: 33% had a good outcome. Five patients were treated by ICH evacuation, followed by aneurysm coiling: None had a good outcome. Conclusions It was necessary to realise a prospective study to compare the outcomes of patients with WFNS scores of 1, 2 or 3; between those with aneurysm coiling followed by ICH evacuation and aneurysm clipping with ICH evacuation, to determine the potential of using the coiling first, for these patients.

Causes of neurological deficits following clipping of 200 consecutive ruptured aneurysms in patients with good-grade aneurysmal subarachnoid haemorrhage

2010 ◽  
Vol 153 (2) ◽  
pp. 295-303 ◽  
Author(s):  
Diederik O. Bulters ◽  
Thomas Santarius ◽  
H. Ling Chia ◽  
Richard A. Parker ◽  
Rikin Trivedi ◽  
...  
Keyword(s):  
Subarachnoid Haemorrhage ◽  
Neurological Deficits ◽  
Aneurysmal Subarachnoid Haemorrhage ◽  
Ruptured Aneurysms ◽  
Good Grade
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