Abstract WP500: Long-Term Cognitive Outcome Among Aneurysmal Subarachnoid Hemorrhage Survivors: Need for Cognitive Rehabilitation?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Danny Samkutty ◽  
Claire Delpirou Nouh ◽  
Swathy Chandrashekhar ◽  
Lance Ford ◽  
Chao Xu ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cognitive Rehabilitation ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cognitive Status ◽  
Cognitive Outcome ◽  
Categorical Variables ◽  
Care Practice ◽  
P Value ◽  
Study Cohort

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high in-patient mortality and with long-term cognitive deficits among survivors. With widespread adoption of standard neurocritical care practice in-hospital mortality has decreased while long-term cognitive impairment (CI) among survivors is not well characterized. Hypothesis: To investigate whether temporal change in practice has resulted in improvement in long-term CI. Methods: Single-center retrospective chart review of aSAH patients admitted to a comprehensive stroke center between January 2012 and December 2016, were identified from a prospective database. Cognitive status was evaluated between January and December 2018 using Telephone Interview of Cognitive Status (TICS). The study cohort was divided into two 2.5 year periods and TICS score of >32, 28-32 and <28 were classified as normal cognitive function, mild and moderate-to-severe CI respectively. The median TICS scores by groups were examined by Wilcoxon or Kruskal-Wallace tests. Categorical variables compared using Chi-squared or Fisher’s exact tests. Results: 252 patients were admitted during the study period of which 46 patients could be reached and consented to participate in TICS. Median TICS score was lower in earlier study period compared to later period [31.5 (IQR 22, 36) vs. 33 (IQR 27, 38), p=0.038]. Similarly, TICS score <28 was seen more often in earlier period as compared to later period [7/22 (6%) vs. 1/24 (0.7%), p=0.044]. Patient who were smokers and had hyperlipidemia had lower TICS score compared to other groups in multivariate model (p=0.007). We found no statistical association between duration of time between discharge date and date of cognitive assessment and TICS groups (Kruskal-Wallace test; p-value=0.074). However, if we treat TICS as a continuous variable in a linear model we observed a significant association between time elapsed and overall TICS score (p=0.0197). For every month increase, there is a decrease in overall TICS by 0.09. Conclusion: Smoking and hyperlipidemia are identified as risk factors for CI among aSAH survivors alluding to a role of vascular pathogenesis. Progressive CI over time might justify long-term cognitive rehabilitation in this population of patients.

COILING VERSUS CLIPPING FOR THE TREATMENT OF ANEURYSMAL SUBARACHNOID HEMORRHAGE

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 434-442 ◽  
Author(s):  
Duncan Frazer ◽  
Abha Ahuja ◽  
Laurence Watkins ◽  
Lisa Cipolotti
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Intellectual Functioning ◽  
Acute Stage ◽  
Cognitive Outcome ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Significant Difference ◽  
Prospective Longitudinal

Abstract OBJECTIVE Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. The aim of the present study was to provide a prospective, longitudinal investigation into cognitive function in patients with aneurysmal subarachnoid hemorrhage treated with either neurosurgical clipping or endovascular coiling. METHODS Twenty-three patients who were treated for aneurysmal subarachnoid hemorrhage at the National Hospital for Neurology and Neurosurgery in London, England, were recruited prospectively. Twelve patients who underwent surgical clipping were compared with a group of 11 patients who underwent endovascular coiling. All patients underwent a comprehensive, standardized neuropsychological assessment using the same battery of tests at the acute stage (within 2 wk after treatment). All patients who underwent coiling and 11 of the 12 patients who underwent clipping were reassessed at the post-acute long-term follow-up (6 mo) stage. RESULTS Group comparisons at the acute assessment revealed a significant difference favoring coiling patients on only one measure of verbal recall. However, there were no other significant differences between the groups at this stage. At the post-acute assessment, the clipped group performed better than the coiled group on measures of intellectual functioning (P &lt; 0.05), although no other differences were found on a range of cognitive tests. Intragroup comparisons between the acute and post-acute assessments found equivocal, significant improvements in measures of intellectual functioning, memory, executive functions, and speed of information processing in both groups of patients. CONCLUSION We argue that there are minimal differences in the long-term cognitive outcome between endovascular coiling and surgical clipping. In the acute phase after treatment, we suggest that coiled patients, having been spared neurosurgical intervention, may have a slightly better cognitive outcome than clipped patients. However, these differences level off and both groups of patients ultimately experience widespread improvement in cognitive functioning by the post-acute stage of recovery.

scholarly journals Predictive Factors for Seizures and Efficacy of Antiepileptic Drugs in Patients with Aneurysmal Subarachnoid Hemorrhage

2020 ◽  
Vol 54 (2) ◽  
Author(s):  
Ronnie E. Baticulon ◽  
Kevin Ivan P. Chan ◽  
Peter Paul P. Rivera ◽  
Gerardo D. Legaspi ◽  
Willy G. Lopez
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Antiepileptic Drugs ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Categorical Variables ◽  
P Value ◽  
Clinical Factors ◽  
Significant Difference ◽  
Clip Occlusion ◽  
Ruptured Intracranial Aneurysms

Objectives. To identify factors that predict the occurrence of seizures in patients with aneurysmal subarachnoid hemorrhage (SAH) and to evaluate the efficacy of antiepileptic drugs (AEDs) in preventing in-hospital seizures among patients who undergo clip occlusion of ruptured intracranial aneurysms. Methods. In this retrospective study, the medical charts of 205 patients admitted for aneurysmal SAH in Philippine General Hospital (PGH) and who underwent craniotomy and clipping of aneurysm from January 2011 to June 2014 were reviewed. Demographic, radiologic, and clinical factors were converted into categorical variables and their association with the occurrence of seizures analyzed. The incidence of seizures among patients who received an AED (AED cohort) and those who did not receive an AED (No AED cohort) were compared. Secondarily, the effects of seizures and AED use on early postoperative outcomes were determined using the Glasgow Outcome Scale (GOS) on the day of discharge. Results. Among 205 patients with aneurysmal SAH, 31 (15.1%) developed seizures. 21 (10.2%) had seizures at onset of SAH and only seven (3.4%) had in-hospital seizures. Aneurysm re-rupture (OR 5.26, p-value 0.045) and the presence of a parenchymal clot (OR 2.90, p-value 0.043) were independent predictors for seizure occurrence. There was no significant difference in the incidence of seizures in the AED cohort and in the No AED cohort (4/100, 4% vs. 3/99, 3%, p-value 0.714). AED use was associated with a higher proportion of patients with a discharge GOS score of 3 or less (28.0% vs 12.1%, p-value 0.005). Conclusion. The results of the study do not support the routine use of AEDs in patients with aneurysmal SAH.

scholarly journals Endovascular Perforation Subarachnoid Hemorrhage Fails to Cause Morris Water Maze Deficits in the Mouse

2014 ◽  
Vol 34 (9) ◽  
pp. e1-e9 ◽  
Author(s):  
Eric Milner ◽  
Jacob C Holtzman ◽  
Stuart Friess ◽  
Richard E Hartman ◽  
David L Brody ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Morris Water Maze ◽  
Water Maze ◽  
Genetic Manipulation ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Cognitive Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Primary Driver

Cognitive dysfunction is the primary driver of poor long-term outcome in aneurysmal subarachnoid hemorrhage (SAH) survivors; modeling such deficits preclinically is thus key for mechanistic and translational investigation. Although rat SAH causes long-term deficits in learning and memory, it remains unknown whether similar deficits are seen in the mouse, a species particularly amenable to powerful, targeted genetic manipulation. We thus subjected mice to endovascular perforation SAH and assessed long-term cognitive outcome via the Morris water maze (MWM), the most commonly used metric for rodent neurocognition. No significant differences in MWM performance (by either of two protocols) were seen in SAH versus sham mice. Moreover, SAH caused negligible hippocampal CA1 injury. These results undercut the potential of commonly used methods (of SAH induction and assessment of long-term neurocognitive outcome) for use in targeted molecular studies of SAH-induced cognitive deficits in the mouse.

Severity of cerebral vasospasm associated with development of collaterals following aneurysmal subarachnoid hemorrhage

2018 ◽  
Vol 10 (7) ◽  
pp. 638-643
Author(s):  
Fawaz Al-Mufti ◽  
Jens Witsch ◽  
Nathan Manning ◽  
Michael Crimmins ◽  
Krishna Amuluru ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Vasospasm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Delayed Cerebral Ischemia ◽  
Weighted Kappa ◽  
Observational Cohort Study ◽  
Cognitive Outcome ◽  
Multivariable Model ◽  
Final Infarct Size ◽  
Observational Cohort

IntroductionCerebral collateral circulation has been studied extensively in ischemic stroke where it has been shown to be a predictor of reperfusion, final infarct size, and outcome. Little is known about the significance of the collaterals in the setting of aneurysmal subarachnoid hemorrhage (aSAH). We sought to evaluate the effect of cerebral vasospasm on the development of cerebral collaterals following aneurysmal subarachnoid hemorrhage and the effects of the latter on delayed cerebral ischemia (DCI).MethodsWe retrospectively evaluated 64 aSAH patients with evidence of DCI between day 5 and 7, enrolled in a prospectively maintained observational cohort study. Angiograms were evaluated by four blinded neurointerventionalists. We compared good collateral grades to poor collateral grades, additionally we compared enrolled individuals with any collaterals versus patients who had no collaterals.ResultsInter-rater reliability for collateral grades was substantial (weighted kappa 0.632). Mild vasospasm was more frequent in patients with poor collateral grades compared with patients with good collateral grades (32% vs 4% P=0.012). There was no difference between the collateral groups with regards to DCI, functional, or cognitive outcome. Patients adjudicated to have any collaterals were more likely to have severe vasospasm (62% vs 33% P=0.023) and less likely to have mild vasospasm (37% vs 9% P=0.007). In a multivariable model, vasospasm severity remained associated with collateral status, while aneurysm location was not.ConclusionsThe severity of vasospasm following aSAH was associated with the development of collaterals. There was no difference between collateral grades with regards to DCI or outcome.

Predictors of long-term Health-Related Quality of Life in patients with aneurysmal subarachnoid hemorrhage

2010 ◽  
Vol 30 (2) ◽  
pp. 137-145 ◽  
Author(s):  
P.E.C.A. Passier ◽  
J.M.A. Visser-Meily ◽  
M.J.E. van Zandvoort ◽  
G.J.E. Rinkel ◽  
E. Lindeman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Abstract 194: Cognitive Outcome in Acute Simvastatin Treatment for Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
George Wong ◽  
Keyword(s):  
Cognitive Impairment ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Infarction ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Primary Outcome Measure ◽  
Cognitive Outcomes ◽  
Cognitive Outcome ◽  
Secondary Outcome ◽  
Modified Rankin Scale ◽  
Simvastatin Treatment

Objectives: Experimental evidence has indicated the benefit of simvastatin in the treatment of subarachnoid haemorrhage (SAH). Recently, acute simvastatin treatment was not shown to be beneficial in neurological outcome using modified Rankin Scale. Cognitive function is another important dimension of outcome assessment and yet had not been investigated in statin studies for aneurysmal subarachnoid hemorrhage. We therefore explored whether acute simvastatin treatment would improve cognitive outcomes. Methods: The study recruited SAH patients with acute simvastatin treatment enrolled in a randomized controlled double-blinded clinical trial (ClinicalTrials.gov Identifier: NCT01038193). A control cohort of SAH patients without simvastatin treatment was identified with propensity score matching of age and admission grade. Primary outcome measure was Montreal Cognitive Assessment (MoCA). Secondary outcome measures were delayed ischaemic deficit (DID), delayed cerebral infarction, modified Rankin Scale (mRS), and Mini-Mental State Examination( MMSE). Results: Fifty-one SAH patients with acute simvastatin treatment and 51 SAH patients without simvastatin treatment were recruited for analysis. At 3 months, there were no differences in MoCA scores (MoCA: 21+/-6 vs. 21+/-5, p=0.772). MoCA-assessed cognitive impairment (MoCA<26) was not different (75% vs. 80%, OR 0.7, 95%CI 0.3 to 1.8, p=0.477). There were also no differences in DID, delayed cerebral infarction, favorable mRS outcome, and MMSE scores, and MMSE-assessed cognitive impairment between both groups. Conclusions: The current study does not support that acute simvastatin treatment improves cognitive outcome after aneurysmal subarachnoid hemorrhage.

Abstract TP425: How do Different Outcome Measures Reflect Outcome After Aneurysmal Subarachnoid Hemorrhage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Daniel Haenggi ◽  
Nima Etminan ◽  
Hans Jakob Steiger ◽  
R. Loch Macdonald ◽  
Stephan A Mayer ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Outcome Measures ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Phase 1 ◽  
External Ventricular Drain ◽  
Cognitive Status ◽  
World Federation ◽  
Cognitive Assessments ◽  
Dose Escalation Study ◽  
Sustained Release Formulation

Few treatments for aneurysmal subarachnoid hemorrhage (aSAH) have been effective in randomized clinical studies. One reason may be that the outcome measures used are not sensitive enough to detect efficacy of treatments in this disease. This hypothesis was examined by comparing 6 outcome measures for 72 patients with aSAH. Patients with aSAH who were World Federation of Neurological Surgeons grades 2 to 4 with an external ventricular drain inserted as part of standard of care were entered in a Phase 1/2a multicenter, controlled, randomized, open-label, dose escalation study to determine the maximum tolerated dose and safety and tolerability of a sustained release formulation of nimodipine (EG-1962, NEWTON study) in patients with aSAH. Clinical outcome was assessed at 90 days after aSAH using the extended Glasgow outcome scale (eGOS), modified Rankin scale (mRS), Montreal cognitive assessment (MoCA), telephone interview of cognitive status (TICS), NIHSS and Barthel index. The relationship between each outcome measure and the eGOS was plotted on arithmetic graphs (Figure). The eGOS and mRS gave very similar results. More detailed cognitive assessments (MoCA, TICS) were more exponential in shape with more variability. The NIHSS and Barthel had outcomes clustered towards the highest ends of the scales with distributions that did not discriminate as much as the eGOS or mRS. The MoCA and TICS gave similar results. It was concluded that the eGOS or mRS produce a similar and varying range of outcomes after aSAH, whereas cognitive assessments like the MoCA and TICS and scales designed for ischemic stroke like the NIHSS and BI are less discriminatory of outcomes after aSAH.

scholarly journals Assessment of the Subarachnoid Hemorrhage International Trialists (SAHIT) Models for Dichotomized Long-Term Functional Outcome Prediction After Aneurysmal Subarachnoid Hemorrhage in a United Kingdom Multicenter Cohort Study

Neurosurgery ◽  
2020 ◽  
Author(s):  
Isabel C Hostettler ◽  
Menelaos Pavlou ◽  
Gareth Ambler ◽  
Varinder S Alg ◽  
Stephen Bonner ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Predictive Performance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Fisher Grade

Abstract BACKGROUND Long-term outcome after subarachnoid hemorrhage, beyond the first few months, is difficult to predict, but has critical relevance to patients, their families, and carers. OBJECTIVE To assess the performance of the Subarachnoid Hemorrhage International Trialists (SAHIT) prediction models, which were initially designed to predict short-term (90 d) outcome, as predictors of long-term (2 yr) functional outcome after aneurysmal subarachnoid hemorrhage (aSAH). METHODS We included 1545 patients with angiographically-proven aSAH from the Genetic and Observational Subarachnoid Haemorrhage (GOSH) study recruited at 22 hospitals between 2011 and 2014. We collected data on age, WNFS grade on admission, history of hypertension, Fisher grade, aneurysm size and location, as well as treatment modality. Functional outcome was measured by the Glasgow Outcome Scale (GOS) with GOS 1 to 3 corresponding to unfavorable and 4 to 5 to favorable functional outcome, according to the SAHIT models. The SAHIT models were assessed for long-term outcome prediction by estimating measures of calibration (calibration slope) and discrimination (area under the receiver-operating characteristic curve [AUC]) in relation to poor clinical outcome. RESULTS Follow-up was standardized to 2 yr using imputation methods. All 3 SAHIT models demonstrated acceptable predictive performance for long-term functional outcome. The estimated AUC was 0.71 (95% CI: 0.65-0.76), 0.73 (95% CI: 0.68-0.77), and 0.74 (95% CI: 0.69-0.79) for the core, neuroimaging, and full models, respectively; the calibration slopes were 0.86, 0.84, and 0.89, indicating good calibration. CONCLUSION The SAHIT prediction models, incorporating simple factors available on hospital admission, show good predictive performance for long-term functional outcome after aSAH.

306 GCS Does Not Predict Cognitive Outcome 30 Years After Severe Traumatic Brain Injury

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 264-265
Author(s):  
Molly E Hubbard ◽  
Abdullah Bin Zahid ◽  
Gabrielle Meyer ◽  
Kathleen Vonderhaar ◽  
David Y Balser ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Assessment Tool ◽  
Cognitive Status ◽  
Cognitive Outcomes ◽  
Cognitive Outcome ◽  
Symptom Severity Score ◽  
History Of ◽  
Severe Tbi

Abstract INTRODUCTION Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in the US. The effects of TBI on quality of life may not become apparent for years after the injury. There are conflicting reports in the literature regarding long term outcomes. Physicians are often asked to predict long term functional and cognitive outcomes, with limited data available. METHODS Patients with severe TBI (GCS = 9) who previously participated in a clinical trial during the 1980s were followed up with and compared to healthy controls without history of TBI. A health questionnaire, sports concussion assessment tool version 3 (SCAT3) and the Telephone Interview for Cognitive Status-modified (TICS-m) were completed over the phone and compared with controls using t-test. GCS at admission and 12-month GRS were used to predict to TICS-M at 30 years using linear regression. RESULTS >45 of the initial 168 subjects were confirmed alive, and 37 (13 females; mean age: 52.43 years S.D. 10.7) consented. Controls (n = 58; 23 females; mean age = 54 years, S.D. 11.5) had lower symptom severity score (6.7 S.D. 12.6 versus 20.6 S.D. 25.3; P = 0.005), lower total number of symptoms (3.4 S.D. 4.7 versus 7.12 S.D. 6.5; P = 0.006), higher standardized assessment of concussion score (25.6 S.D. 2.8 versus 21.2 S.D. 6.9; P = 0.001), and lower corrected MPAI-4 (22.3 S.D. 17.0 versus 43.7 S.D. 12.8; P < 0.001). GCS at admission did not predict cognitive status at 30-years assessed using TICS-M (P = 0.345). The Glasgow Outcome Scale score at 12-months was correlated to TICS-M at 30 years (R = 0.548, P < 0.001); each point decrease in GOS decreasing the score at TICS-M by 5.6 points. CONCLUSION Remote history of TBI disrupts the lives of survivors long after injury. Admission GCS does not predict cognitive status 30 years after TBI. The GOS at 12-months predicted the cognitive status assessed using TICS-M score at 30 years.

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