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Characteristics of patients without neuropsychological deficits following aneurysmal subarachnoid haemorrhage
Book Chapter - Jan 1, 2014
Stienen Martin N., Weisshaupt Rahel, Fandino Javier, Hildebrandt Gerhard, Studerusgermann A, Schatlo Bawarjan
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Background: Previous studies have shown that the incidence of neuropsychological deficits (NPD) after aneurysmal subarachnoid haemorrhage (aSAH) is high despite excellent outcome evaluated by traditional neurological grading scales. The aim of this study was to elucidate the clinical characteristics in patients presenting with aSAH who had a good clinical outcome without NPD.
Methods: Files of patients treated for aSAH between 01/2009 and between 08/2012 at the neurovascular centres of the Kantonsspital St. Gallen (KSSG) and Kantonsspital Aarau (KSA), respectively, were reviewed. Neuropsychological outcome was assessed by an experienced, independent neuropsychologist.
Results: A total of 92 patients (35 men and 57 women) with a mean age of 51.4 ± 11.6 years were analysed. Eight of 92 patients (8.7 %) had no NPD at follow-up. Patients with-out NPD were admitted with lower median WFNS (1.00 vs. 2.00; p=0.011) and Fisher grades (2.00 vs. 3.00; p=0.001). They were equally distributed between clipping and coiling (four patients each). No patient with regular neuropsychological outcome displayed chronic hydrocephalus (p = 0.019) or developed delayed cerebral ischaemia (DCI) during the hospital course (p=0.100). Five patients were graded as modified Rankin Scale (mRS) 0 and three patients as mRS 1 at discharge.
Conclusion: Patients without NPD after aSAH are likely to present with mild admission scores, develop no chronic hydrocephalus and to be spared from DCI. In this series the aneurysm occlusion modality did not influence the cognitive outcome.