Skip to main content
SpringerLink
Log in

Long-term domain-specific improvement following poor grade aneurysmal subarachnoid hemorrhage

  • ORIGINAL COMMUNICATION
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Background

While efforts have been made to document short-term outcomes following poor grade aneurysmal subarachnoid hemorrhage (aSAH), no data exist concerning the degree of delayed improvement in neurological function. Here we assess cognitive function, level of independence, and quality of life (QoL) over 12 months following poor grade aSAH.

Methods

Data on definitively treated poor grade patients (Hunt and Hess grade IV or V) surviving 12 months post-aSAH were obtained through a prospectively maintained SAH database. Demographic information, medical history, and clinical course were analyzed. Health outcomes assessments completed by surviving patients at discharge (DC), three months (3 M) and 12 months (12 M) follow-up, including the Telephone Interview for Cognitive Status (TICS), Barthel Index (BI), and Sickness Impact Profile (SIP), were used to evaluate cognitive function, level of independence, and QoL.

Findings

Fifty-six poor grade patients underwent aneurysm-securing intervention and survived at least 12 months post-aSAH. Thirty-five (63%) surviving patients underwent health outcomes assessments at DC, 3 M and 12 M post-aSAH. A majority of patients had improved scores on the TICS (DC to 3 M: 91%; 3 M to 12 M: 82%), BI (DC to 3 M: 96%; 3 M to 12 M: 92%), and SIP (3 M to 12 M: 80%) following aSAH. Using paired-sample analyses, significant improvement on each test was observed.

Conclusion

A substantial portion of patients experience cognitive recovery, increased independence, and improved QoL following poor grade aSAH. Delayed follow-up assessments are necessary when evaluating functional recovery in this population. These findings have the potential to impact poor grade aSAH management and prognosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. German Stroke Study Collaboration (2004) Predicting outcome after acute ischemic stroke: an external validation of prognostic models. Neurology 62:581–585

    Google Scholar 

  2. Brandt J, Spencer M, Folstein M (1988) The Telephone Interview for Cognitive Status. Neuropsychiatry Neuropsychol Behav Neurol 1:111–117

    Google Scholar 

  3. Butefisch CM (2004) Plasticity in the human cerebral cortex: lessons from the normal brain and from stroke. Neuroscientist 10:163–173

    Article  PubMed  Google Scholar 

  4. Carter BS, Buckley D, Ferraro R, Rordorf G, Ogilvy CS (2000) Factors associated with reintegration to normal living after subarachnoid hemorrhage. Neurosurgery 46:1326–1333; discussion 1333–1324

    Article  PubMed  CAS  Google Scholar 

  5. Chiang VL, Claus EB, Awad IA (2000) Toward more rational prediction of outcome in patients with high-grade subarachnoid hemorrhage. Neurosurgery 46:28–35; discussion 35–26

    Article  PubMed  CAS  Google Scholar 

  6. Copeland D, Kreiter K, Peery S, et al. (2000) What is the best scale for assessing quality of life after subarachnoid hemorrhage? (Abstract). Ann Neurol 48:21

    Article  Google Scholar 

  7. Damiano A (1996) Sickness Impact Profile. User’s Manual and Interpretation Guide. The Johns Hopkins University Press, Baltimore

    Google Scholar 

  8. Disney L, Weir B, Grace M (1988) Factors influencing the outcome of aneurysm rupture in poor grade patients: a prospective series. Neurosurgery 23:1–9

    PubMed  CAS  Google Scholar 

  9. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6:1–9

    PubMed  CAS  Google Scholar 

  10. Fjaertoft H, Indredavik B, Lydersen S (2003) Stroke unit care combined with early supported discharge: long-term follow-up of a randomized controlled trial. Stroke 34:2687–2691

    Article  PubMed  Google Scholar 

  11. Hallett M (2001) Plasticity of the human motor cortex and recovery from stroke. Brain Res Brain Res Rev 36:169–174

    Article  PubMed  CAS  Google Scholar 

  12. Hirai S, Ono J, Yamaura A (1996) Clinical grading and outcome after early surgery in aneurysmal subarachnoid hemorrhage. Neurosurgery 39:441–446; discussion 446–447

    Article  PubMed  CAS  Google Scholar 

  13. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28:14–20

    PubMed  CAS  Google Scholar 

  14. Hutchinson PJ, Power DM, Tripathi P, Kirkpatrick PJ (2000) Outcome from poor grade aneurysmal subarachnoid haemorrhage–which poor grade subarachnoid haemorrhage patients benefit from aneurysm clipping? Br J Neurosurg 14:105–109

    Article  PubMed  CAS  Google Scholar 

  15. Hutchinson PJ, Seeley HM, Kirkpatrick PJ (1998) Factors implicated in deaths from subarachnoid haemorrhage: are they avoidable? Br J Neurosurg 12:37–40

    Article  PubMed  CAS  Google Scholar 

  16. Kassell NF, Torner JC, Jane JA, Haley EC Jr., Adams HP (1990) The International Cooperative Study on the Timing of Aneurysm Surgery. Part 2: Surgical results. J Neurosurg 73:37–47

    PubMed  CAS  Google Scholar 

  17. Laidlaw JD, Siu KH (2003) Poor-grade aneurysmal subarachnoid hemorrhage: outcome after treatment with urgent surgery. Neurosurgery 53:1275–1280; discussion 1280–1272

    Article  PubMed  Google Scholar 

  18. Laidlaw JD, Siu KH (2002) Ultra-early surgery for aneurysmal subarachnoid hemorrhage: outcomes for a consecutive series of 391 patients not selected by grade or age. J Neurosurg 97:250–258; discussion 247–259

    PubMed  Google Scholar 

  19. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    PubMed  CAS  Google Scholar 

  20. Le Roux PD, Elliott JP, Newell DW, Grady MS, Winn HR (1996) Predicting outcome in poor-grade patients with subarachnoid hemorrhage: a retrospective review of 159 aggressively managed cases. J Neurosurg 85:39–49

    Article  PubMed  CAS  Google Scholar 

  21. Lee KC, Huh SK, Park HS, Shin YS, Lee KS (1997) Management of poor-grade patients with ruptured intracranial aneurysm. Keio J Med 46:69–73

    PubMed  CAS  Google Scholar 

  22. Lindsay KW, Teasdale G, Knill-Jones RP, Murray L (1982) Observer variability in grading patients with subarachnoid hemorrhage. J Neurosurg 56:628–633

    Article  PubMed  CAS  Google Scholar 

  23. Longstreth WT Jr., Nelson LM, Koepsell TD, van Belle G (1993) Clinical course of spontaneous subarachnoid hemorrhage: a population-based study in King County, Washington. Neurology 43:712–718

    PubMed  Google Scholar 

  24. Mahoney FI, Barthel DW (1965) Functional Evaluation: The Barthel Index. Md State Med J 14:61–65

    PubMed  CAS  Google Scholar 

  25. Mahurin R, Cooke N (1996) Verbal Series Attention Test: Clinical Utility in the Assessment of Dementia. Clin Neuropsychologist 10:43–53

    Google Scholar 

  26. Mayer SA, Kreiter KT, Copeland D, Bernardini GL, Bates JE, Peery S, Claassen J, Du YE, Connolly ES Jr (2002) Global and domain-specific cognitive impairment and outcome after subarachnoid hemorrhage. Neurology 59:1750–1758

    PubMed  CAS  Google Scholar 

  27. Naidech AM, Kreiter KT, Janjua N, Ostapkovich N, Parra A, Commichau C, Connolly ES, Mayer SA, Fitzsimmons BF (2005) Phenytoin exposure is associated with functional and cognitive disability after subarachnoid hemorrhage. Stroke 36:583–587

    Article  PubMed  CAS  Google Scholar 

  28. Nowak G, Schwachenwald R, Arnold H (1994) Early management in poor grade aneurysm patients. Acta Neurochir (Wien) 126:33–37

    Article  CAS  Google Scholar 

  29. Oder W, Kollegger H, Zeiler K, Dal-Bianco P, Wessely P, Deecke L (1991) Subarachnoid hemorrhage of unknown etiology: early prognostic factors for long-term functional capacity. J Neurosurg 74:601–605

    PubMed  CAS  Google Scholar 

  30. Oshiro EM, Walter KA, Piantadosi S, Witham TF, Tamargo RJ (1997) A new subarachnoid hemorrhage grading system based on the Glasgow Coma Scale: a comparison with the Hunt and Hess and World Federation of Neurological Surgeons Scales in a clinical series. Neurosurgery 41:140–147; discussion 147–148

    Article  PubMed  CAS  Google Scholar 

  31. Seifert V, Trost HA, Stolke D (1990) Management morbidity and mortality in grade IV and V patients with aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien) 103:5–10

    Article  CAS  Google Scholar 

  32. Uchino K, Billheimer D, Cramer SC (2001) Entry criteria and baseline characteristics predict outcome in acute stroke trials. Stroke 32:909–916

    PubMed  CAS  Google Scholar 

  33. van Straten A, de Haan RJ, Limburg M, van den Bos GA (2000) Clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 and the Sickness Impact Profile-136. Stroke 31:2610–2615

    PubMed  Google Scholar 

  34. van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19:604–607

    PubMed  Google Scholar 

  35. Weimar C, Ziegler A, Konig IR, Diener HC (2002) Predicting functional outcome and survival after acute ischemic stroke. J Neurol 249:888–895

    Article  PubMed  Google Scholar 

  36. Weir RU, Marcellus ML, Do HM, Steinberg GK, Marks MP (2003) Aneurysmal subarachnoid hemorrhage in patients with Hunt and Hess grade 4 or 5: treatment using the Guglielmi detachable coil system. AJNR Am J Neuroradiol 24:585–590

    PubMed  Google Scholar 

  37. Zentner J, Hoffmann C, Schramm J (1996) Results of early surgery in poor-grade aneurysm patients. J Neurosurg Sci 40:183–188

    PubMed  CAS  Google Scholar 

Download references

Acknowledgement

J Mocco was supported by the Congress of Neurological Surgeons Wilder Penfield Clinical Research Fellowship. Evan R. Ransom was supported by a Doris Duke Clinical Research Fellowship. Ricardo J. Komotar was supported by an N.I.H. Research Training Fellowship. Stephan A. Mayer was supported by grant-in-aid (9750432N) from the American Heart Association.

Author information

Authors and Affiliations

  1. Dept. of Neurological Surgery, Columbia University, New York, NY, USA

    J. Mocco MD, Evan R. Ransom BA, Ricardo J. Komotar MD, Paulina B. Sergot BS, Stephan A. Mayer MD & E. Sander Connolly Jr. MD

  2. Dept. of Neurology, Columbia University, New York, NY, USA

    Noeleen Ostapkovich MS, J. Michael Schmidt PhD, Kurt T. Kreiter PhD & Stephan A. Mayer MD

  3. Dept. of Neurosurgery, Columbia University, 630 West 168th Street, Room 5-454, New York, NY, 10032, USA

    Ricardo J. Komotar MD

Authors
  1. J. Mocco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Evan R. Ransom BA
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ricardo J. Komotar MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paulina B. Sergot BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Noeleen Ostapkovich MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Michael Schmidt PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kurt T. Kreiter PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stephan A. Mayer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. E. Sander Connolly Jr. MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ricardo J. Komotar MD.

Additional information

Received in revised form: 24 July 2005

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mocco, J., Ransom, E.R., Komotar, R.J. et al. Long-term domain-specific improvement following poor grade aneurysmal subarachnoid hemorrhage. J Neurol 253, 1278–1284 (2006). https://doi.org/10.1007/s00415-006-0179-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-006-0179-y

Keywords

Search

Navigation