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  • Clinical assessment of deficits after SAH - hasty neurosurgeons and accurate neurologists

    Final Number:
    340

    Authors:
    Christian Fung MD; Jürgen Beck; Lara Lauber; René Müri; Andreas Raabe MD; Thomas Nyffeler

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: For survivors of aneurysmal subarachnoid hemorrhage (SAH), somatic and cognitive deficits can affect long-term outcomes. We were interested in comparing the deficits identified in SAH patients, including cognitive, at discharge by neurosurgeons and deficits identified by neurologists upon admission to the rehabilitation unit on the same day. The assessment of deficits might have an impact on referring patients to rehabilitation.

    Methods: This retrospective study included 494 SAH patients treated between 2005-2010. Of these, 50 patients were discharged to an affiliated rehabilitation unit. Deficits were grouped into 18 categories and summarized into three groups: major somatic, minor somatic and cognitive deficits.

    Results: Major somatic deficits were identified in 16 and 20 patients (P=0.53), minor somatic deficits in 16 and 44 (P<0.0001) patients, and cognitive deficits in 36 and 45 (P<0.04) by neurosurgeons and neurologists, respectively. The absolute number of deficits in daily activities identified by the neurosurgeon and neurologist were 21 and 31 major somatic deficits (P=0.2), 18 and 97 minor somatic deficits (P<0.0001), and 61 and 147 cognitive deficits (P<0.0001), respectively.

    Conclusions: Significant differences in assessment of cognitive and minor somatic deficits between neurosurgeons and neurologists exist. Based on these findings it is evident that for the neurosurgeon, there needs to be an increased awareness in the assessment of cognitive deficits and a more routine interdisciplinary approach, including the use of neuropsychological evaluations, to ensure a better triage of patients to rehabilitation or for discharge home.

    Patient Care: This research might improve patient care by raising the awareness about cognitive deficits after SAH.

    Learning Objectives: By the end of this session the participants should be 1) aware that cognitive deficits after SAH are more frequent than expected and 2) that an interdisciplinary approach including neuropsychologists is useful in patient care

    References: 1. Molyneux AJ, Kerr RS, Yu LM, et al (2005) International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet 366:809–817. 2. Meyer B, Ringel F, Winter Y, et al (2010) Health-related quality of life in patients with subarachnoid haemorrhage. Cerebrovasc Dis 30:423–431. 3. Hackett ML, Anderson CS (2000) Health outcomes 1 year after subarachnoid hemorrhage: An international population-based study. The Australian Cooperative Research on Subarachnoid Hemorrhage Study Group. Neurology 55:658–662. 4. Visser-Meily JM, Rhebergen ML, Rinkel GJ, van Zandvoort MJ, Post MW (2009) Long-term health-related quality of life after aneurysmal subarachnoid hemorrhage: relationship with psychological symptoms and personality characteristics. Stroke 40:1526–1529. 5. Powell J, Kitchen N, Heslin J, Greenwood R (2002) Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis. J Neurol Neurosurg Psychiatry 72:772–781. 6. Springer MV, Schmidt JM, Wartenberg KE, Frontera JA, Badjatia N, Mayer SA (2009) Predictors of global cognitive impairment 1 year after subarachnoid hemorrhage. Neurosurgery 65:1043–1050. 7. Passier PE, Visser-Meily JM, van Zandvoort MJ, Post MW, Rinkel GJ, van Heugten C (2010) Prevalence and determinants of cognitive complaints after aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis 29:557–563. 8. Kim DH, Haney CL, Van Ginhoven G (2005) Utility of outcome measures after treatment for intracranial aneurysms: a prospective trial involving 520 patients. Stroke 36:792–796. 9. Saciri BM, Kos N. (2002) Aneurysmal subarachnoid haemorrhage: outcomes of early rehabilitation after surgical repair of ruptured intracranial aneurysms. J Neurol Neurosurg Psychiatry 72:334–337.

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