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Objective: Early aneurysm repair and improved intensive care management have led a decreased mortality in patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) over the past decades. As a consequence, more than 70% of patients survive and 40% have a good neurological outcome as measured by widely accepted scales such as the modified Rankin Scale (mRS) or the Glasgow Outcome Scale (GOS). Prior studies have shown that up to 62% of patients are left with neuropsychological deficits (NPD) six months after the bleed despite excellent neurological outcome (GOS 5) (Hütter et al., 1993, PMID 8134014). While it remains impossible to predict which patient will survive aSAH without NPD today, it was our aim to analyze patients with regular cognitive assessment following aSAH.

Methods: Files of patients treated for aSAH between 01-2009 and 08-2012 at two neurovascular centres (KSSG or KSA) were reviewed. Neuropsychological deficits were graded as regular (no deficit), minimum, moderate or severe by an experienced neuropsychologist. Neuropsychological assessment was performed 70.4 ± 67.3 days after aneurysm occlusion (42% within the 1st month; 37% between 1-4 months and 20% between 4-12 months).

Results: A total of 92 patients (35 male and 57 female) with a mean age of 51.4 ± 11.6 years were analyzed. Despite the good neurological outcome according to the mRS scale only eight of 92 patients (8.7%) had no NPD at follow-up. Seven out of these eight patients (87.5%) presented with a WFNS score of 1, the remaining patient had a WFNS score of 2. The patients without NPD displayed lower Fisher grades at admission: 3 with grade 1; 4 with grade 2; 1 with grade 4. Fisher grade 1 or 2 hemorrhage was associated with a reduced risk of developing NPD as compared to Fisher grades 3 or 4 (Chi2: p=0.03). Patients without NPD were equally distributed between clipping and coiling (four patients each). Only one patient without NPD had evidence of cerebral vasospasm compared to 38/84 patients with NPD (12.5% vs. 45%; Chi2 p=0.07). In total, 28/92 patients (30%) developed DIND. No patient without NPD suffered DIND (0/8), while 28/86 patients with NPD had DIND (0% vs. 33%; Chi2 p=0.05). None without NPD displayed hydrocephalus during or after the hospital stay compared to 38 out of 84 patients (45%) in the remaining groups (Chi2: p=0.013).

Conclusion: Patients who suffer no neuropsychological deficits have lower WFNS and Fisher scores at admission. The likelihood of a regular cognitive outcome is higher in patients without hydrocephalus. Our data set reveals a trend towards a higher likelihood of good neuropsychological outcome in patients without either DIND or cerebral vasospasm. There was no impact of aneurysm occlusion modality (clipping and coiling) on cognitive outcome.