Evolution of neurological recovery during the first year after subarachnoid haemorrhage in a French university centre

Raphaël Cinotti; Jean-Baptiste Putegnat; Karim Lakhal; Hubert Desal; Amandine Chenet; Kévin Buffenoir; Denis Frasca; Bernard Allaouchiche; Karim Asehnoune; Bertrand Rozec

doi:10.1016/j.accpm.2018.10.002

Evolution of neurological recovery during the first year after subarachnoid haemorrhage in a French university centre

Anaesth Crit Care Pain Med. 2019 Jun;38(3):251-257. doi: 10.1016/j.accpm.2018.10.002. Epub 2018 Oct 25.

Authors

Affiliations

¹ Anaesthesia and critical care department, Hôtel Dieu, 1, place Alexis-Ricordeau 44093 Nantes, university hospital of Nantes, France. Electronic address: [email protected].
² Anaesthesia and critical care department, centre régional hospitalier universitaire, route de Chauvel, Les Abymes, BP 465, 97159, Pointe-à-Pitre cedex, Guadeloupe, France. Electronic address: [email protected].
³ Anaesthesia and critical care department, hôpital Guillaume et René-Laennec, university hospital of Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France. Electronic address: [email protected].
⁴ Department of neuroradiology, hôpital Guillaume et René-Laennec, university hospital of Nantes boulevard Jacques-Monod, 44800 Saint-Herblain, France. Electronic address: [email protected].
⁵ Service de médecine physique et de réadaptation, hôpital Saint-Jacques, university hospital of Nantes, 85, rue Saint-Jacques, 44200 Nantes, France. Electronic address: [email protected].
⁶ Department of neurotraumatology, university hospital of Nantes Hôtel Dieu, 1, place Alexis-Ricordeau 44093 Nantes, France. Electronic address: [email protected].
⁷ Anaesthesia and critical care department, centre hospitalo-universitaire, university hospital of Poitiers 2, rue de la Milétrie 86021, Poitiers, France; Inserm SPHERE U1246 "Methods for Patients-centered outcomes and Health Research", UFR des sciences pharmaceutiques, university of Nantes, university of Tours, 22, boulevard Benoni-Goullin, 44200 Nantes, France. Electronic address: [email protected].
⁸ Intensive care unit, anaesthesia and critical care department, centre hospitalier Lyon-Sud, Pierre-Bénite France Hospice Civils de Lyon 165, chemin du Grand Revoyet, 69310, France; Université Claude Bernard Lyon 1, 43, boulevard du 11 Novembre 1918, 69100, Villeurbanne, France; Université de Lyon, VetAgroSup, APCSé, 1, avenue Bourgelat, 69280, Marcy-l'Etoile, France. Electronic address: [email protected].
⁹ Anaesthesia and critical care department, Hôtel Dieu, 1, place Alexis-Ricordeau 44093 Nantes, university hospital of Nantes, France; Laboratoire UPRES EA 3826 "Thérapeutiques cliniques et expérimentales des infections" university hospital of Nantes. 22, boulevard Benoni-Goullin, 44200 Nantes, France. Electronic address: [email protected].
¹⁰ Anaesthesia and critical care department, hôpital Guillaume et René-Laennec, university hospital of Nantes, boulevard Jacques-Monod, 44800 Saint-Herblain, France; Institut du thorax, Inserm UMR1087 IRT, UN 8 quai Moncousu, University hospital of Nantes, BP 7072 44007 Nantes cedex 1, France. Electronic address: [email protected].

PMID: 31079704
DOI: 10.1016/j.accpm.2018.10.002

Abstract

Introduction: The evolution of neurological recovery during the first year after aneurysmal Subarachnoid Haemorrhage (SAH) is poorly described.

Patients: Patients with SAH in one university hospital from March the 1st 2010, to December 31st 2012, with a one-year follow-up.

Method: Evaluation was performed via phone call at 3, 6 and 12 months. Primary endpoint was poor neurological recovery (modified Rankin Scale 3-4-5-6), one year after SAH. Secondary endpoints were the incidence of lack of self-perceived previous health status recovery and incidence of cognitive disorders, one year after SAH. Risk factors of poor neurological recovery were retrieved with multivariable logistic regression.

Results: Two hundred and eleven patients were included and 208 had a complete follow-up. One hundred and twenty (57.7%) patients were female, 112 (53.8%) had a WFNS grade I-II-III. Seventy (33.6%) patients displayed one-year poor neurological outcome and risk factors of poor outcome were age, baseline Glasgow Coma Score ≤ 8, external ventricular drainage, intra-cranial hypertension and angiographic vasospasm. We observed an improvement in good outcome at 3 months [112 (53.8%) patients], 6 months [127 (61.1%) patients] and one-year [138 (66.3%) patients]. Fifty-nine (35.3%) patients recovered previous health status, 96 (57.5%) had persistent behaviour disorders, and 71 (42.5%) suffered from memory losses at one year.

Discussion: Neurological recovery seems to improve over time. The same key complications should be targeted worldwide in SAH patients.

Conclusion: Neurological complications in the following of SAH should be actively treated in order to improve outcome. The early neuro-ICU phase remains a key determinant of long-term recovery.

Keywords: Outcome; Recovery; Subarachnoid haemorrhage.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Age Factors
Aged
Drainage / adverse effects
Embolization, Therapeutic / instrumentation
Embolization, Therapeutic / methods
Female
France
Glasgow Coma Scale
Health Status
Hospitals, University
Humans
Intracranial Aneurysm / complications*
Intracranial Aneurysm / therapy
Intracranial Hypertension / complications
Intracranial Hypertension / diagnosis
Male
Memory Disorders / etiology
Mental Disorders / etiology
Middle Aged
Risk Factors
Subarachnoid Hemorrhage / complications*
Subarachnoid Hemorrhage / physiopathology
Subarachnoid Hemorrhage / therapy
Tertiary Care Centers
Time Factors
Vasospasm, Intracranial / complications
Vasospasm, Intracranial / diagnostic imaging
Vasospasm, Intracranial / therapy