Loss of Consciousness at Onset of Aneurysmal SAH: Poor Prognosis
January 1, 2016 2 minutes read
By Matthew E. Fink, MD
Professor and Chairman, Department of Neurology, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital
Dr. Fink reports he is a consultant for Procter & Gamble and Pfizer.
SOURCE: Suwatcharangkoon S, et al. Loss of consciousness at onset of subarachnoid hemorrhage as an important marker of early brain injury JAMA Neurol 2015; Nov. 9. doi:10.1001/jamaneurol.2015.3188 [Epub ahead of print].
Aneurysmal subarachnoid hemorrhage (SAH) is one of the few acute neurological disorders that may present with out-of-hospital respiratory and cardiac arrest, in the setting of loss of consciousness. The authors did a retrospective analysis of 1460 consecutively treated patients at a large urban academic medical center to identify those patients who had loss of consciousness at onset of hemorrhage and assessed their treatment and prognosis. Outcome was measured using the modified Rankin scale score, 12 months after onset of illness. In the study, 590 patients (40.4%) reported loss of consciousness at the onset of SAH, and this was associated with poor clinical grade on admission, more subarachnoid and intraventricular blood seen on CT scan, and a higher frequency of generalized cerebral edema. These patients also had more episodes of seizure-like activity, and about 10% presented with cardiopulmonary arrest compared to < 1% of patients who did not experience loss of consciousness. Death or severe disability at 12 months was independently associated with loss of consciousness, after adjustment for other risk factors, with an adjusted odds ratio of 1.94 compared to those without loss of consciousness. During the hospital course, loss of consciousness at onset was not associated with rebleeding of the aneurysm or delayed cerebral ischemia. Loss of consciousness at onset of SAH is an indicator of early brain injury and predicts poor functional outcome or death at 12 months.
Loss of consciousness at onset of Aneurysmal subarachnoid hemorrhage is an indicator of early brain injury and predicts poor functional outcome or death at 12 months.
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