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62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

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Neuroendocrine and neuropsychological outcome 12 months after aneurysmal subarachnoid hemorrhage: A prospective cohort study

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  • M. Seiz-Rosenhagen - Medizinische Universität Innsbruck, Neurochirurgische Klinik, Innsbruck, Österreich
  • G.A. Schubert - Medizinische Universität Innsbruck, Neurochirurgische Klinik, Innsbruck, Österreich
  • K. Schmieder - Universitätsmedizin Mannheim, Neurochirurgische Klinik, Mannheim, Deutschland
  • C. Thomé - Medizinische Universität Innsbruck, Neurochirurgische Klinik, Innsbruck, Österreich
  • K. Zohsel - Universitätsmedizin Mannheim, Neurologische Klinik, Mannheim, Deutschland
  • A. Lammert - Universitätsmedizin Mannheim, Medizinische Klinik V, Mannheim, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.11.06

doi: 10.3205/11dgnc083, urn:nbn:de:0183-11dgnc0835

Published: April 28, 2011

© 2011 Seiz-Rosenhagen et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: Neuropsychological deficits are common in patients after aneurysmal subarachnoid hemorrhage (aSAH). Symptoms in patients with primary hypothalamic-pituitary disease resemble those observed in patients with aSAH. Neuro-endocrine deficits may occur in up to 47% of patients suffering from aSAH. In a prospective cohort study we evaluated the incidence of neuroendocrine and neuropsychological deficits after aSAH and their interrelations. Here, we present the results 12 months after aSAH.

Methods: 93 patients were treated for aSAH from March 2008 to November 2008; 26 patients were prospectively enrolled in the study who fulfilled the inclusion criteria (acute aSAH, admission within 12 hours after onset, Hunt and Hess (H-H) grade I-IV, Fisher grade 3 and 4 on the initial CT, treatment within 24 hours, GOS 4 or 5). Patients were evaluated 3, 6 and 12 (20 patients) months after aSAH. Endocrine function was evaluated by basal hormone testing, ACTH stimulation and insulin tolerance testing in case of suspected insufficiency. Neuropyschological testing contained verbal comprehension, visual neglect, verbal and visual short-term and working memory, visuospatial construction as well as figural memory, psychomotor speed, attention and concentration and mental flexibility.

Results: No life-threatening event due to adrenal insufficency was found over the 12-month follow-up. There was a high incidence of neuropsychological deficits 3 months after aSAH in 57%, which persisted in up to 52.5% after 6 months and in 42.1% after 12 months. The kind of treatment (clipping vs. coiling) had no influence on the prevalence of neuropsychological deficits (p=0.9178). In our series, a low incidence of neuroendocrine dysfunction was detected after 3 and 6 months with spontaneous normalization after 12 months. Absolute hormone concentrations demonstrated no conclusive association with neuropsychological deficits or known risk factors of inferior clinical outcome like vasospasm.

Conclusions: Neuroendocrine changes seem to represent an adaption to critical illness due to spontaneous normalization within one year after aSAH. Routine testing is not recommended. The high incidence of neuropsychological impairment shows the need for extensive rehabilitation after SAH.