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Abdelgadir J, Gelman J, Dutko L, Mehta V, Friedman A, Zomorodi A. Cognitive outcomes following aneurysmal subarachnoid hemorrhage: Rehabilitation strategies. World Neurosurg X 2024; 22:100341. [PMID: 38450248 PMCID: PMC10914592 DOI: 10.1016/j.wnsx.2024.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Despite decreases in mortality rate, the treatment of cognitive deficits following aneurysmal subarachnoid hemorrhage (aSAH) remains a serious challenge for clinicians and survivors alike. Deficits in executive function, language, and memory prevent more than half of survivors from returning to their previous level of work and put a tremendous amount of stress on the individual and their family. New therapies are needed for survivors of aSAH in order to improve cognitive outcomes and quality of life. The aim of this review is to discuss the prevalence and contributing factors of cognitive deficits following aSAH, as well as areas for therapeutic intervention. Due to the limited research on cognitive rehabilitative strategies for aSAH, a literature search of traumatic brain injury (TBI) was used to explore therapies with the potential to improve cognitive outcomes in aSAH. Across cognitive domains, existing rehabilitative and pharmacotherapeutic strategies for TBI show promise to be useful for survivors of aSAH. However, further study of these therapies in addition to consistent assessment of cognitive deficits are required to determine their efficacy in survivors of aSAH.
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Affiliation(s)
- Jihad Abdelgadir
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Justin Gelman
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Lindsay Dutko
- Duke Speech Pathology, Duke University Medical Center, Durham, NC, USA
| | - Vikram Mehta
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Allan Friedman
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA
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2
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Rajdev K, Mehan S. Neuroprotective Methodologies of Co-Enzyme Q10 Mediated Brain Hemorrhagic Treatment: Clinical and Pre-Clinical Findings. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2020; 18:446-465. [PMID: 31187715 DOI: 10.2174/1871527318666190610101144] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 04/22/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022]
Abstract
Cerebral brain hemorrhage is associated with the highest mortality and morbidity despite only constituting approximately 10-15% of all strokes classified into intracerebral and intraventricular hemorrhage where most of the patients suffer from impairment in memory, weakness or paralysis in arms or legs, headache, fatigue, gait abnormality and cognitive dysfunctions. Understanding molecular pathology and finding the worsening cause of hemorrhage will lead to explore the therapeutic interventions that could prevent and cure the disease. Mitochondrial ETC-complexes dysfunction has been found to increase neuroinflammatory cytokines, oxidative free radicals, excitotoxicity, neurotransmitter and energy imbalance that are the key neuropathological hallmarks of cerebral hemorrhage. Coenzyme Q10 (CoQ10), as a part of the mitochondrial respiratory chain can effectively restore these neuronal dysfunctions by preventing the opening of mitochondrial membrane transition pore, thereby counteracting cell death events as well as exerts an anti-inflammatory effect by influencing the expression of NF-kB1 dependent genes thus preventing the neuroinflammation and energy restoration. Due to behavior and biochemical heterogeneity in post cerebral brain hemorrhagic pattern different preclinical autologous blood injection models are required to precisely investigate the forthcoming therapeutic strategies. Despite emerging pre-clinical research and resultant large clinical trials for promising symptomatic treatments, there are very less pharmacological interventions demonstrated to improve post operative condition of patients where intensive care is required. Therefore, in current review, we explore the disease pattern, clinical and pre-clinical interventions under investigation and neuroprotective methodologies of CoQ10 precursors to ameliorate post brain hemorrhagic conditions.
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Affiliation(s)
- Kajal Rajdev
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
| | - Sidharth Mehan
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
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3
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Ray B, Ross SR, Danala G, Aghaei F, Nouh CD, Ford L, Hollabaugh KM, Karfonta BN, Santucci JA, Cornwell BO, Bohnstedt BN, Zheng B, Dale GL, Prodan CI. Systemic response of coated-platelet and peripheral blood inflammatory cell indices after aneurysmal subarachnoid hemorrhage and long-term clinical outcome. J Crit Care 2019; 52:1-9. [PMID: 30904732 PMCID: PMC8663918 DOI: 10.1016/j.jcrc.2019.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/11/2019] [Accepted: 03/13/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Post-hemorrhage period after aneurysmal subarachnoid hemorrhage (aSAH) has several systemic manifestations including prothrombotic and pro-inflammatory states. Inter-relationship between these states using established/routine laboratory biomarkers and its long-term effect on clinical outcome is not well-defined. MATERIALS AND METHODS Retrospective analysis of prospective cohort of 44 aSAH patients. Trend of procoagulant biomarkers [coated-platelets, mean platelet volume to platelet count (MPV:PLT)] and peripheral inflammatory biomarkers [platelet-lymphocyte ratio (PLR), neutrophil-platelet ratio (NLR)] were analyzed using regression analysis. Occurrence of delayed cerebral ischemia (DCI), modified Rankin score (mRS) of 3-6 and Montreal cognitive assessment (MoCA) of <26 at 1-year defined adverse clinical outcome. RESULTS Patients with worse mRS and MoCA score had higher rise in coated-platelet compared to those with better scores [20.4 (IQR: 15.6, 32.9) vs. 10.95 (IQR: 6.1, 18.9), p = 0.003] and [16.9 (IQR: 13.4, 28.1) vs. 10.95 (IQR: 6.35, 18.65), p = 0.02] respectively. NLR and PLR trends showed significant initial decline followed by a gradual rise in NLR among those without DCI as compared to persistent low levels in those developing DCI (0.13 units/day vs. -0.07 units/day, p = 0.06). CONCLUSIONS Coated-platelet rise after aSAH is associated with adverse long-term clinical outcome. NLR and PLR trends show an early immune-depressed state after aSAH.
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Affiliation(s)
- Bappaditya Ray
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Stephen R Ross
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Faranak Aghaei
- Electrical Engineering, University of Oklahoma, Norman, OK, USA
| | - Claire Delpirou Nouh
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lance Ford
- Biostatistics & Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kimberly M Hollabaugh
- Biostatistics & Epidemiology, College of Public Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Brittany N Karfonta
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joshua A Santucci
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Benjamin O Cornwell
- Radiology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bradley N Bohnstedt
- Neurosurgery, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bin Zheng
- Electrical Engineering, University of Oklahoma, Norman, OK, USA
| | - George L Dale
- Internal Medicine, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Calin I Prodan
- Departments of Neurology, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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4
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Huenges Wajer IMC, Hendriks ME, Witkamp TD, Hendrikse J, Rinkel GJE, Visser-Meily JMA, van Zandvoort MJE, Vergouwen MDI, de Vis JB. The relationship between ischaemic brain lesions and cognitive outcome after aneurysmal subarachnoid haemorrhage. J Neurol 2019; 266:2252-2257. [PMID: 31161387 PMCID: PMC6689896 DOI: 10.1007/s00415-019-09408-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022]
Abstract
Background Cerebral ischaemia is thought to be an important determinant of cognitive outcome after aneurysmal subarachnoid haemorrhage (aSAH), but the exact relationship is unclear. We studied the effect of ischaemic brain lesions during clinical course on cognitive outcome 2 months after aSAH. Methods We studied 74 consecutive patients admitted to the University Medical Center Utrecht who had MRI post-coiling (3–21 days post-aSAH) and neuropsychological examination at 2 months. An ischaemic lesion was defined as hyperintensity on T2-FLAIR and DWI images. We measured both cognitive complaints (subjective) and cognitive functioning (objective). The relationship between ischaemic brain lesions and cognitive outcome was analysed by logistic regression analyses. Results In 40 of 74 patients (54%), 152 ischaemic lesions were found. The median number of lesions per patient was 2 (1–37) and the median total lesion volume was 0.2 (0–17.4) mL. No difference was found between the group with and the group without ischaemic lesions with respect to the frequency of cognitive complaints. In the group with ischaemic lesions, significantly more patients (55%) showed poor cognitive functioning compared to the group without ischaemic lesions (26%) (OR 3.4, 95% CI 1.3–9.1). We found no relationship between the number and volume of the ischaemic lesions and cognitive functioning. Conclusions Ischaemic brain lesions detected on MRI during clinical course after aSAH is a marker for poor cognitive functioning 2 months after aSAH, irrespective of the number or volume of the ischaemic lesions. Network or connectivity studies are needed to better understand the relationship between location of the ischaemic brain lesions and cognitive functioning.
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Affiliation(s)
- I M C Huenges Wajer
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - M E Hendriks
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - T D Witkamp
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J Hendrikse
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - G J E Rinkel
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J M A Visser-Meily
- Department of Rehabilitation, University Medical Center Utrecht and Center of Excellence in Rehabilitation Medicine, Utrecht University, Rehabilitation Center de Hoogstraat, Utrecht, The Netherlands
| | - M J E van Zandvoort
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - M D I Vergouwen
- Department of Neurology and Neurosurgery, G03.232, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - J B de Vis
- National Institute of Health, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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James RF, Khattar NK, Aljuboori ZS, Page PS, Shao EY, Carter LM, Meyer KS, Daniels MW, Craycroft J, Gaughen JR, Chaudry MI, Rai SN, Everhart DE, Simard JM. Continuous infusion of low-dose unfractionated heparin after aneurysmal subarachnoid hemorrhage: a preliminary study of cognitive outcomes. J Neurosurg 2019; 130:1460-1467. [PMID: 29749915 DOI: 10.3171/2017.11.jns17894] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/29/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cognitive dysfunction occurs in up to 70% of aneurysmal subarachnoid hemorrhage (aSAH) survivors. Low-dose intravenous heparin (LDIVH) infusion using the Maryland protocol was recently shown to reduce clinical vasospasm and vasospasm-related infarction. In this study, the Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive changes in aSAH patients treated with the Maryland LDIVH protocol compared with controls. METHODS A retrospective analysis of all patients treated for aSAH between July 2009 and April 2014 was conducted. Beginning in 2012, aSAH patients were treated with LDIVH in the postprocedural period. The MoCA was administered to all aSAH survivors prospectively during routine follow-up visits, at least 3 months after aSAH, by trained staff blinded to treatment status. Mean MoCA scores were compared between groups, and regression analyses were performed for relevant factors. RESULTS No significant differences in baseline characteristics were observed between groups. The mean MoCA score for the LDIVH group (n = 25) was 26.4 compared with 22.7 in controls (n = 22) (p = 0.013). Serious cognitive impairment (MoCA ≤ 20) was observed in 32% of controls compared with 0% in the LDIVH group (p = 0.008). Linear regression analysis demonstrated that only LDIVH was associated with a positive influence on MoCA scores (β = 3.68, p =0.019), whereas anterior communicating artery aneurysms and fevers were negatively associated with MoCA scores. Multivariable linear regression analysis resulted in all 3 factors maintaining significance. There were no treatment complications. CONCLUSIONS This preliminary study suggests that the Maryland LDIVH protocol may improve cognitive outcomes in aSAH patients. A randomized controlled trial is needed to determine the safety and potential benefit of unfractionated heparin in aSAH patients.
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Affiliation(s)
- Robert F James
- 1Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
- 2Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Nicolas K Khattar
- 1Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Zaid S Aljuboori
- 1Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Paul S Page
- 1Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Elaine Y Shao
- 2Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Lacey M Carter
- 2Department of Surgery, Brody School of Medicine at East Carolina University, Greenville, North Carolina
| | - Kimberly S Meyer
- 1Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michael W Daniels
- 3Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health, Louisville, Kentucky
| | - John Craycroft
- 3Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health, Louisville, Kentucky
| | - John R Gaughen
- 4Sentara Martha Jefferson Hospital, Charlottesville, Virginia
| | - M Imran Chaudry
- 5Comprehensive Stroke and Cerebrovascular Center, Medical University of South Carolina, Charleston, South Carolina
| | - Shesh N Rai
- 3Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health, Louisville, Kentucky
| | - D Erik Everhart
- Departments of6Psychology and
- 7Internal Medicine, East Carolina University, Greenville, North Carolina; and
| | - J Marc Simard
- Departments of8Neurosurgery
- 9Pathology, and
- 10Physiology, University of Maryland School of Medicine, Baltimore, Maryland
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6
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Renfrow JJ, Frey CD, Arnel M, Wolfe SQ, McLouth C, Datar S. Utility of cerebrospinal fluid lactate in aneurysmal subarachnoid hemorrhage. Surg Neurol Int 2018; 9:155. [PMID: 30159199 PMCID: PMC6094496 DOI: 10.4103/sni.sni_105_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 06/14/2018] [Indexed: 12/26/2022] Open
Abstract
Background: An external ventricular drain (EVD) treats hydrocephalus in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study examines the utility of cerebrospinal fluid (CSF) lactate collected from an EVD as a proposed biomarker to predict patient outcome and vasospasm/delayed cerebral ischemia. Methods: Consecutive adults admitted to Wake Forest Baptist Medical Center from 2010 to 2015 with aSAH were identified through the electronic medical record, and clinical variables were collected and analyzed for correlation with incidence of vasospasm and discharge outcome. Results: In all, 51 patients with aSAH and an EVD had CSF lactate measured which ranged from 1.9 to 6.2 mmol/L, with a median value of 3.2 mmol/L. Vasospasm based on transcranial Doppler assessment occurred in 29 patients (57%), of which 20 (45%) were clinically symptomatic. Good outcome (discharge to home/acute rehab) occurred in 35 patients (69%). Sixteen patients (31%) had an unfavorable outcome (died/discharged to nursing homes/long-term acute care facility). In multivariate regression analysis, unfavorable outcome at discharge (P = 0.02), elevated CSF protein (P = 0.04), and admission Hunt and Hess score 3–5 (P = 0.05) were significantly associated with higher CSF lactate. The risk of symptomatic vasospasm increased with lactate in univariate analysis, but did not reach statistical significance (P = 0.077). Conclusion: The measurement of the CSF biochemical markers using an EVD is feasible and safe. We found that elevated CSF lactate correlates with patient outcome. Larger prospective studies are needed to test the validity of this finding and for understanding the underlying pathophysiologic mechanisms.
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Affiliation(s)
- Jaclyn J Renfrow
- Department of Neurological Surgery, Section of Neurocritical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Casey D Frey
- Department of Neurological Surgery, Section of Neurocritical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Madison Arnel
- Department of Neurological Surgery, Section of Neurocritical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Stacey Q Wolfe
- Department of Neurological Surgery, Section of Neurocritical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Christopher McLouth
- Department of Biostatistics, Section of Neurocritical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Sudhir Datar
- Departments of Neurology and Anesthesiology, Section of Neurocritical Care, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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7
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Risk Factors for Mild Cognitive Impairment in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Endovascular Coiling. World Neurosurg 2018; 119:e527-e533. [PMID: 30075259 DOI: 10.1016/j.wneu.2018.07.196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To assess the potential early risk factors of mild cognitive impairment after aneurysmal subarachnoid hemorrhage. METHODS We prospectively enrolled patients with aneurysmal subarachnoid hemorrhage treated with endovascular coiling during a 5-year period. The demographic characteristics and radiologic and laboratory data were collected. Cognitive assessments were carried out using the Montreal Cognitive Assessment at 6 months after ictus. Multivariate logistic regression was used to determine the risk factors associated with the development of mild cognitive impairment. RESULTS Of 152 patients, 59 patients (39%) developed cognitive impairment 6 months later. Univariate analysis showed that the patients with anterior communicating artery or anterior cerebral artery aneurysms (P < 0.001) with Glasgow Outcome Scale score of 7 or less at ictus (P = 0.002), Hunt and Hess grade of 3 or higher (P = 0.002), and Fisher grade of 3 or higher (P = 0.032) were more likely to develop mild cognitive impairment. The risk of mild cognitive impairment was increased for patients who had delayed cerebral ischemia (P = 0.040) and hydrocephalus (P = 0.002). In multivariate logistic regression analysis, mild cognitive impairment was independently associated with anterior communicating artery or anterior cerebral aneurysms (odds ratio [OR], 11.046; 95% confidence interval [CI], 3.371-36.198; P < 0.001), delayed cerebral ischemia (OR, 6.153; 95% CI, 1.587-23.855; P = 0.009), and hydrocephalus (OR, 8.768; 95% CI, 2.115-36.345; P = 0.003). CONCLUSIONS The location of the aneurysm, delayed cerebral ischemia, and hydrocephalus were independently associated with the occurrence of mild cognitive impairment after aneurysmal subarachnoid hemorrhage and can contribute to improved identification of patients at high risk for mild cognitive impairment.
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8
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Zaki Ghali MG, Srinivasan VM, Wagner K, Rao C, Chen SR, Johnson JN, Kan P. Cognitive Sequelae of Unruptured and Ruptured Intracranial Aneurysms and their Treatment: Modalities for Neuropsychological Assessment. World Neurosurg 2018; 120:537-549. [PMID: 29966787 DOI: 10.1016/j.wneu.2018.06.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive sequelae frequently follow subarachnoid hemorrhage (SAH) and include deficits across multiple domains of executive function. This factor affects overall functional outcomes negatively, especially in younger patients. Several clinical correlates predict development and severity of cognitive dysfunction after SAH. Hypothetical mechanisms of cognitive dysfunction in the absence of radiographic lesion include cerebral hypoperfusion and blood breakdown products, resulting in perturbed interneuronal communication and network synchrony, excitotoxicity, and altered microRNA expression. METHODS The PubMed database was searched for articles discussing cognitive outcomes in patients with unruptured and ruptured intracranial aneurysmal disease, sequelae of treatment, and modalities for neuropsychologic testing. RESULTS Treatment of unruptured intracranial aneurysms, although capable of preventing SAH, comes with its own set of complications and may also affect cognitive function. Neuropsychological tests such as the Montreal Cognitive Assessment, Mini-Mental Status Examination, and others have proved useful in evaluating cognitive decline. Studies using functional neurologic imaging modalities have identified regions with altered activation patterns during various cognitive tasks. The sum of research efforts in this field has provided useful insights and an initial understanding of cognitive dysfunction after aneurysm treatment and SAH that should prove useful in guiding and rendering future investigations more fruitful. CONCLUSIONS Development of finer and more sensitive neuropsychological tests in evaluating the different domains of cognitive function after aneurysm treatment and SAH in general will be useful in accurately determining outcomes after ictus and comparing efficacy of different therapeutic strategies.
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Affiliation(s)
| | | | - Kathryn Wagner
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Chethan Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Stephen R Chen
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Jeremiah N Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
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9
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Wong GKC, Nung RCH, Sitt JCM, Mok VCT, Wong A, Ho FLY, Poon WS, Wang D, Abrigo J, Siu DYW. Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage. Stroke 2015; 46:3099-104. [PMID: 26419967 DOI: 10.1161/strokeaha.115.010844] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/26/2015] [Indexed: 11/16/2022]
Affiliation(s)
- George Kwok Chu Wong
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Ryan Chi Hang Nung
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Jacqueline Ching Man Sitt
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Vincent Chung Tong Mok
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Adrian Wong
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Faith Lok Yan Ho
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Wai Sang Poon
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Defeng Wang
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Jill Abrigo
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
| | - Deyond Yun Woon Siu
- From the Division of Neurosurgery, Department of Surgery (G.K.C.W., F.L.Y.H., W.S.P.), Department of Imaging and Interventional Radiology (R.C.H.N., J.C.M.S., D.W., J.A.), and Division of Neurology, Department of Medicine and Therapeutics (V.C.T.M., A.W.), Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China; and Department of Diagnostic Radiology, Kwong Wah Hospital, Hong Kong, China (D.Y.W.S.)
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Wilson SJ, Drackford R, Holt M. A Retrospective Study of Survivors of Endovascular Coiling for Posterior and Anterior Aneurysms: Medical and Patient Perspectives. Medicine (Baltimore) 2015; 94:e1313. [PMID: 26266373 PMCID: PMC4616686 DOI: 10.1097/md.0000000000001313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This article documents the longer-term medical and psychosocial outcomes of patients referred for endovascular coiling.There is limited research investigating outcome following endovascular coiling for posterior compared to anterior circulation aneurysms, and minimal understanding of how medical outcomes relate to patient experiences of treatment and quality of life.We studied a consecutive cohort of 80 patients referred Australia wide for endovascular coiling between 1995 and 2003 (49% posterior; 76% ruptured; 69% women, mean age 51.5 years). We used a mixed methods approach, assessing medical outcome with the Modified Rankin Scale (MRS) in 61 patients (76%), and health-related quality of life and psychosocial functioning using the EuroQol questionnaire and a qualitative semistructured interview in 49 patients (61%).Despite the high proportion of posterior aneurysms, the majority of patients (80%) showed good medical outcomes as indicated by regained independence of activities of daily living (MRS score ≤3). Patients with unruptured aneurysms were significantly more likely to show good outcomes (P < 0.04), whereas aneurysm location (posterior, anterior, or mixed) showed no significant effect. In patients with good medical outcomes, greater functional disability was associated with neurological complications surrounding treatment (P < 0.05). Good outcomes correlated with higher EuroQol ratings (P < 0.001) and the experience of less change after treatment (P < 0.001), although psychosocial adjustment issues were reported by most of the patients, including those with no medical symptoms.These results support the long-term efficacy of endovascular coiling, particularly for posterior circulation aneurysms. They have implications for guiding clinicians and patients in their choice of treatment, as well as the provision of psychological counseling for patient adjustment issues posttreatment.
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Affiliation(s)
- Sarah J Wilson
- From the Melbourne School of Psychological Sciences (SJW, RD), The University of Melbourne, Parkville; and Department of Radiology (MH), Monash Medical Centre, Clayton, Victoria, Australia
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Altered Resting-State Connectivity within Executive Networks after Aneurysmal Subarachnoid Hemorrhage. PLoS One 2015; 10:e0130483. [PMID: 26172281 PMCID: PMC4501762 DOI: 10.1371/journal.pone.0130483] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 05/19/2015] [Indexed: 01/02/2023] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant mortality rates, and most survivors experience significant cognitive deficits across multiple domains, including executive function. It is critical to determine the neural basis for executive deficits in aSAH, in order to better understand and improve patient outcomes. This study is the first examination of resting-state functional Magnetic Resonance Imaging in a group of aSAH patients, used to characterize changes in functional connectivity of the frontoparietal network. We scanned 14 aSAH patients and 14 healthy controls, and divided patients into “impaired” and “unimpaired” groups based on a composite executive function score. Impaired patients exhibited significantly lower quality of life and neuropsychological impairment relative to controls, across multiple domains. Seed-based functional connectivity analysis demonstrated that unimpaired patients were not significantly different from controls, but impaired patients had increased frontoparietal connectivity. Patients evidenced increased frontoparietal connectivity as a function of decreased executive function and decreased mood (i.e. quality of life). In addition, T1 morphometric analysis demonstrated that these changes are not attributable to local cortical atrophy among aSAH patients. These results establish significant, reliable changes in the endogenous brain dynamics of aSAH patients, that are related to cognitive and mood outcomes.
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Uchikawa K, Inaba M, Kagami H, Ichimura S, Fujiwara T, Tsuji T, Otaka Y, Liu M. Executive dysfunction is related with decreased frontal lobe blood flow in patients with subarachnoid haemorrhage. Brain Inj 2013; 28:15-9. [DOI: 10.3109/02699052.2013.847209] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Brand C, Alber B, Fladung AK, Knauer K, König R, Oechsner A, Schneider IL, Tumani H, Widder B, Wirtz CR, Woischneck D, Kapapa T. Cognitive performance following spontaneous subarachnoid haemorrhage versus other forms of intracranial haemorrhage. Br J Neurosurg 2013; 28:68-80. [DOI: 10.3109/02688697.2013.815314] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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14
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Kamp MA, Dibué M, Etminan N, Steiger HJ, Schneider T, Hänggi D. Evidence for direct impairment of neuronal function by subarachnoid metabolites following SAH. Acta Neurochir (Wien) 2013. [PMID: 23180171 DOI: 10.1007/s00701-012-1559-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dysfunction of neuronal signal processing and transmission occurs after subarachnoid hemorrhage (SAH) and contributes to the high morbidity and mortality of this pathology. The underlying mechanisms include early brain injury due to elevation of the intracranial pressure, disruption of the blood-brain barrier, brain edema, reduction of cerebral blood flow, and neuronal cell death. Direct influence of subarachnoid blood metabolites on neuronal signaling should be considered. After SAH, some metabolites were shown to directly induce disruption of neuronal integrity and neuronal signaling, whereas the effects of other metabolites on neurotoxicity and neuronal signaling have not yet been investigated. Therefore, this mini-review will discuss recent evidence for a direct influence of subarachnoid blood and its metabolites on neuronal function.
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Affiliation(s)
- Marcel A Kamp
- Department of Neurosurgery, University Hospital, Heinrich-Heine-University, Düsseldorf, Moorenstraße 5, D-40225, Düsseldorf, Germany.
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15
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Abstract
Memory deficits for survivors of aneurysmal subarachnoid hemorrhage (SAH) are common, however, the nature of these deficits is not well understood. In this study, 24 patients with SAH and matched control participants were asked to study six lists containing words from four different categories. For half the lists, the categories were presented together (organized lists). For the remaining lists, the related words were presented randomly to maximize the use of executive processes such as strategy and organization (unorganized lists). Across adjoining lists, there was overlap in the types of categories given, done to promote intrusions. Compared to control participants, SAH patients recalled a similar number of words for the organized lists, but significantly fewer words for the unorganized lists. SAH patients also reported more intrusions than their matched counterparts. Separating patients into anterior communicating artery ruptures (ACoA) and ruptures in other regions, there was a recall deficit only for the unorganized list for those with ACoA ruptures and deficits across both list types for other rupture locations. These results suggest that memory impairment following SAH is likely driven by impairment in the executive components of memory, particularly for those with ACoA ruptures. Such findings may help direct future cognitive-therapeutic programs.
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Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage. Stroke 2010; 41:e519-36. [DOI: 10.1161/strokeaha.110.581975] [Citation(s) in RCA: 455] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Timour Al-Khindi
- From the University of Toronto (T.A.-K.), Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), St Michael’s Hospital, Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada; the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St Michael’s Hospital (R.L.M., T.A.S.), Toronto, Ontario, Canada; and the Heart and Stroke Foundation–Centre for Stroke Recovery (T.A.S.), Ontario, Canada
| | - R. Loch Macdonald
- From the University of Toronto (T.A.-K.), Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), St Michael’s Hospital, Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada; the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St Michael’s Hospital (R.L.M., T.A.S.), Toronto, Ontario, Canada; and the Heart and Stroke Foundation–Centre for Stroke Recovery (T.A.S.), Ontario, Canada
| | - Tom A. Schweizer
- From the University of Toronto (T.A.-K.), Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), St Michael’s Hospital, Toronto, Ontario, Canada; the Division of Neurosurgery (R.L.M., T.A.S.), Department of Surgery, University of Toronto, Toronto, Ontario, Canada; the Keenan Research Centre of the Li Ka Shing Knowledge Institute at St Michael’s Hospital (R.L.M., T.A.S.), Toronto, Ontario, Canada; and the Heart and Stroke Foundation–Centre for Stroke Recovery (T.A.S.), Ontario, Canada
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Mukerji N, Holliman D, Baisch S, Noble A, Schenk T, Nath F. Neuropsychologic Impact of Treatment Modalities in Subarachnoid Hemorrhage: Clipping Is No Different from Coiling. World Neurosurg 2010; 74:129-38. [DOI: 10.1016/j.wneu.2010.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 04/30/2010] [Indexed: 10/18/2022]
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Tariq A, Ai J, Chen G, Sabri M, Jeon H, Shang X, Macdonald R. Loss of long-term potentiation in the hippocampus after experimental subarachnoid hemorrhage in rats. Neuroscience 2010; 165:418-26. [DOI: 10.1016/j.neuroscience.2009.10.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 09/29/2009] [Accepted: 10/19/2009] [Indexed: 12/01/2022]
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Wong GKC, Wong R, Mok V, Wong A, Fan D, Leung G, Chan A, Poon WS. Rivastigmine for cognitive impairment after spontaneous subarachnoid haemorrhage: a pilot study. J Clin Pharm Ther 2009; 34:657-63. [DOI: 10.1111/j.1365-2710.2009.01056.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Wong GKC, Wong R, Mok VCT, Fan DSP, Leung G, Wong A, Chan ASY, Zhu CXL, Poon WS. Clinical study on cognitive dysfunction after spontaneous subarachnoid haemorrhage: patient profiles and relationship to cholinergic dysfunction. Acta Neurochir (Wien) 2009; 151:1601-7. [PMID: 19551338 DOI: 10.1007/s00701-009-0425-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Accepted: 05/22/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to explore the cognitive profiles of subarachnoid haemorrhage patients who returned to the community, along with the associated risk factors. METHODS We recruited 40 Chinese patients with spontaneous subarachnoid haemorrhage 7-27 months after the initial presentation. They had all been discharged to their homes or to care homes for the elderly. For cognitive assessment, we employed the Cognitive Subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) for global cognitive function, the Frontal Assessment Battery (FAB) for frontal lobe function, and the Rivermead Behavioural Memory Test (RBMT) for everyday memory function. RESULTS An ADAS-cog of more than 21/85 (poor global cognitive function) was noted in 14 (35%) patients. A FAB of less than 12/18 (poor frontal lobe function) was noted in 13 (27.5%) patients. An RBMT score of less than 15/26 (poor everyday memory function) was noted in 17 (43.6%) patients. Poor cognitive function was found to be associated with chronic hydrocephalus (in terms of FAB), with clinical vasospasm (in terms of RBMT), and with cerebral infarction (in terms of RBMT). CONCLUSIONS Poor cognitive function was common and occurred in up to 43.6% of the patients, with the verbal and behavioural memory aspects predominantly affected. We did not find a significant association between cholinergic dysfunction and cognitive dysfunction. Organization of future drug trials and cognitive rehabilitation should take into account the association between frontal lobe dysfunction and chronic hydrocephalus.
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Müller K, Ingebrigtsen T, Wilsgaard T, Wikran G, Fagerheim T, Romner B, Waterloo K. Prediction of time trends in recovery of cognitive function after mild head injury. Neurosurgery 2009; 64:698-704; discussion 704. [PMID: 19349827 DOI: 10.1227/01.neu.0000340978.42892.78] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate relations between predictors and outcomes, and especially to identify predictors influencing the time trend in recovery after mild traumatic brain injury. METHODS We included 59 patients with mild head injury in a prospective study. They underwent comprehensive assessment with neurological and neuroradiological examinations, serum S-100B analysis, and apolipoprotein E (APOE) genotyping. Neuropsychological testing was performed before and 6 months after discharge. Linear mixed models were used to assess associations between baseline predictors and neurocognitive performance and its change. RESULTS A Glasgow Coma Scale score of less than 15, traumatic brain injury demonstrated with computed tomography, magnetic resonance imaging, and serum S-100B greater than 0.14 microg/L predicted impaired cognitive performance both at baseline and after 6 months; APOE genotype did not. There was significant improvement of performance after 6 months. APOE-epsilon4 genotype was the only independent factor significantly predicting less improvement. CONCLUSION The presence of the APOE-epsilon4 allele predicts less recovery of cognitive function after mild head injury.
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Affiliation(s)
- Kay Müller
- Department of Neurosurgery, University Hospital of North Norway, Tromsø, Norway.
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22
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Bendel P, Koivisto T, Niskanen E, Könönen M, Äikiä M, Hänninen T, Koskenkorva P, Vanninen R. Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study. Neuroradiology 2009; 51:711-22. [DOI: 10.1007/s00234-009-0552-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 06/12/2009] [Indexed: 10/20/2022]
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Barth M, Thomé C, Schmiedek P, Weiss C, Kasuya H, Vajkoczy P. Characterization of functional outcome and quality of life following subarachnoid hemorrhage in patients treated with and without nicardipine prolonged-release implants. J Neurosurg 2009; 110:955-60. [DOI: 10.3171/2008.2.17670] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The use of nicardipine prolonged-release implants (NPRIs) is associated with a significant improvement in the therapy of patients suffering from aneurysmal subarachnoid hemorrhage (aSAH) regarding the occurrence and severity of cerebral vasospasm, new infarcts, and functional outcome (FO). Because quality of life (QOL) measurements more reliably seem to describe the patient's true condition, the present study was conducted to assess FO and QOL 1 year after aneurysm rupture in patients with and without NPRIs.
Methods
From the initial series of 32 patients, 18 were assessed 1 year after aSAH (7 of the control and 11 of the NPRI group). The patients underwent neurological investigation, a structured interview followed by a measurement of QOL (Mini-Mental State Examination [MMSE]; 36-Item Short Form Health Survey [SF-36]; and the Hamilton Depression Rating Scale). There were no intergroup differences in the patient characteristics (that is, localization of aneurysm, initial Hunt and Hess grade, or age).
Results
In addition to the previously reported improvement of the National Institutes of Health Stroke Scale and modified Rankin Scale scores, the NPRI group's Karnofsky Performance Scale and the MMSE scores were markedly to significantly improved (p < 0.05 [Karnofsky Performance Scale] and p = 0.053 [MMSE]). In contrast, anxiety, oblivion, and mild symptoms of depression were equally present in both study groups (p = 0.607 [anxiety]; p = 0.732 [oblivion]; and p = 0.509 [Hamilton Depression Rating Scale]). Furthermore, no intergroup differences were observed in any of the SF-36 domains. The scores in the SF-36 domains of Role-Physical, Vitality, and Role-Emotional were significantly reduced in the NRPI group compared with those observed in an age-matched control population (p < 0.001 [Role-Physical]; p = 0.001 [vitality]; and p = 0.01 [Role-Emotional]). Considering consequent costs, no difference was detectable regarding the duration of in- and outpatient rehabilitation (p = 0.135 and 0.171, respectively) or the Prolo score (p = 0.094).
Conclusions
Despite FO improvement in terms of a lower incidence of cerebral vasospasm, new infarcts, morbidity in the treatment of aSAH in patients with NPRIs, a patient's QOL seems to be related to the severity of the aSAH itself.
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Affiliation(s)
| | | | | | - Christel Weiss
- 2Institute for Biomedical Statistics, University Hospital, Mannheim Faculty for Clinical Medicine, Karl-Ruprecht-University of Heidelberg, Mannheim, Germany; and
| | - Hidetoshi Kasuya
- 3Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Bederson JB, Connolly ES, Batjer HH, Dacey RG, Dion JE, Diringer MN, Duldner JE, Harbaugh RE, Patel AB, Rosenwasser RH. Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke 2009; 40:994-1025. [PMID: 19164800 DOI: 10.1161/strokeaha.108.191395] [Citation(s) in RCA: 923] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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25
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Predictors for cognitive impairment one year after surgery for aneurysmal subarachnoid hemorrhage. J Neurol 2008; 255:1770-6. [DOI: 10.1007/s00415-008-0047-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 05/06/2008] [Accepted: 07/01/2008] [Indexed: 12/29/2022]
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Fauvage B, Canet C, Coppo F, Jacquot C, Payen JF. Devenir à long terme des patients après une HSA anévrismale. ACTA ACUST UNITED AC 2007; 26:959-64. [DOI: 10.1016/j.annfar.2007.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Soehle M, Chatfield DA, Czosnyka M, Kirkpatrick PJ. Predictive value of initial clinical status, intracranial pressure and transcranial Doppler pulsatility after subarachnoid haemorrhage. Acta Neurochir (Wien) 2007; 149:575-83. [PMID: 17460816 DOI: 10.1007/s00701-007-1149-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Accepted: 03/21/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND We examined the predictive value of initial clinical status, mean arterial blood pressure (MABP), intracranial pressure (ICP) and transcranial Doppler (TCD)-derived pulsatility and resistance indices for outcome and quality of life one year following aneurysmal subarachnoid haemorrhage (SAH). METHOD Neuromonitoring was performed in 29 patients following clipping or coiling of an aneurysm. Mean arterial blood pressure was measured in the radial artery and intracranial pressure was assessed via a closed external ventricular drainage. Based on transcranial Doppler-recordings of the middle cerebral artery, Gosling's pulsatility (PI) and Pourcelot's resistance (RI) index were calculated. Glasgow outcome score (GOS) and short form-36 (SF-36) scores were determined one year after SAH. FINDINGS An unfavourable outcome (GOS 1-3) was observed in 34% of patients and correlated significantly (p < 0.05) with a poor initial clinical status, as determined by Glasgow Coma Scale (r = 0.55), Hunt and Hess (r = -0.62), World Federation of Neurosurgical Societies (WFNS) (r = -0.48) and Fisher (r = -0.58) score. Poor outcome was significantly associated with high mean arterial blood pressure (r = -0.44) and intracranial pressure (r = -0.48) as well as increased pulsatility (r = -0.46) and resistance (r = -0.43) indices. Hunt and Hess grade > or = 4 (OR 12.4, 5-95% CI: 1.9-82.3), mean arterial blood pressure > 95 mmHg (19.5, 2.9-132.3), Gosling's pulsatility >0.8 (6.5, 1.6-27.1) and Pourcelot's resistance >0.57 (15.4, 2.3-103.4) were predictive for unfavourable outcome in logistic regression, however TCD-diagnosed vasospasm was not. Except for mental health, significantly reduced scores were observed in all short form-36 domains. Initial clinical status correlated significantly with the physical functioning, role physical, bodily pain, social functioning and physical component summary of short form-36. CONCLUSIONS Mortality and morbidity following SAH remains high, especially in poor-grade patients. Outcome is mainly correlated with initial clinical status, mean arterial blood pressure, intracranial pressure, pulsatility and resistance indices. Those factors seem to be stronger than the influence of vasospasm.
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Affiliation(s)
- M Soehle
- Department of Anaesthesiology and Intensive Care Medicine, University of Bonn, Bonn, Germany.
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Haug T, Sorteberg A, Sorteberg W, Lindegaard KF, Lundar T, Finset A. Cognitive outcome after aneurysmal subarachnoid hemorrhage: time course of recovery and relationship to clinical, radiological, and management parameters. Neurosurgery 2007; 60:649-56; discussion 656-7. [PMID: 17415201 DOI: 10.1227/01.neu.0000255414.70807.a0] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Although many patients show a satisfactory physical outcome after aneurysmal subarachnoid hemorrhage (SAH), disabling cognitive dysfunction may still be present. This study focuses on the time course of cognitive recovery during the first year after aneurysmal SAH, and relates the neuropsychological test results to clinical, radiological, and management parameters. METHODS Thirty-two patients were followed prospectively with neuropsychological examinations at 3, 6, and 12 months after SAH. Test results were compared with clinical entry variables, management variables, and pre- and postoperative radiological findings. RESULTS The time course of cognitive recovery after aneurysmal SAH is heterogeneous, with motor and psychomotor functions recovering within the first 6 months, whereas verbal memory did not improve significantly until at least 6 months after the ictus. Clinical and radiological parameters reflecting the impact of the bleed were related to memory function, intelligence, and aphasia. The site of aneurysm and mode of treatment could not be linked to neuropsychological outcome. The time length of volume-controlled mechanical ventilation as a reflector of the aggregated consequences of being subjected to an aneurysm rupture correlated with both motor and psychomotor functioning and memory performance, predominantly 6 to 12 months after SAH, but was not linked to intelligence or aphasia. CONCLUSION The various cognitive functions have different time courses of recovery, with verbal memory requiring the longest time. Parameters reflecting the impact of the bleed and patient management can be linked to neuropsychological outcome.
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Affiliation(s)
- Tonje Haug
- Department of Neuropsychiatry and Psychosomatic Medicine, The National Hospital Rikshospitalet-Radiumhospitalet Trust, Oslo, Norway.
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