Recovery of cognitive function after surgery for aneurysmal subarachnoid hemorrhage

Satwant K SAMRA; Bruno GIORDANI; Angela F CAVENEY; William R CLARKE; Phillip A SCOTT; Steven ANDERSON; Byron G THOMPSON; Michael M TODD

doi:10.1161/STROKEAHA.106.477448

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Recovery of cognitive function after surgery for aneurysmal subarachnoid hemorrhage

Journal article

Open access

Peer reviewed

Recovery of cognitive function after surgery for aneurysmal subarachnoid hemorrhage

Satwant K SAMRA, Bruno GIORDANI, Angela F CAVENEY, William R CLARKE, Phillip A SCOTT, Steven ANDERSON, Byron G THOMPSON and Michael M TODD

Stroke (1970), Vol.38(6), pp.1864-1872

2007

DOI: 10.1161/STROKEAHA.106.477448

PMID: 17431208

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Abstract

Background and Purpose— Abnormalities in neurocognitive function are common after surgery for aneurysmal subarachnoid hemorrhage, even among patients with good functional outcomes. The time course of neurocognitive recovery, along with the long-term effects of mild intraoperative hypothermia (33°C) and aneurysm location, is unknown. We determined these in a subset of subarachnoid hemorrhage patients enrolled in the Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST). Methods— We performed a longitudinal, multicenter, prospective, blinded study of adult IHAST patients with a Glasgow Outcome Score=1 or 2 (independent function), 3 months postsurgery and a matched control group (n=45). Subjects were tested with a 5-test cognitive function battery and standard neurological evaluations at 3, 9 and 15 months postsurgery. The primary outcome measure was a composite score on cognitive test performance. Results— There were 303 IHAST patients available for inclusion: 218 eligible, 185 enrolled (89 hypothermic, 96 normothermic). Significant cognitive improvement was noted from 3 to 9 (P<0.001) and 3 to 15 (P<0.001) months in both hypothermic and normothermic groups, even after adjusting for practice effects observed in the control group. No significant change was identified between 9 and 15 months. Neither mild hypothermia nor aneurysm location (anterior communicating artery versus others) had a significant effect on recovery over time or frequency of cognitive impairment. Compared with control group, the frequency of cognitive impairment (Z score <−1.96) in all patients at 3, 9 and 15 months was 36%, 26% and 23%, respectively. Conclusions— In this population, cognitive improvement continued beyond 3 months, with a plateau between 9 and 15 months. This was not affected by the use of intraoperative hypothermia or anatomical location of aneurysm.

Neurology

Toxicology

Drug addictions

Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics

Biological and medical sciences

Vascular diseases and vascular malformations of the nervous system

Medical sciences

Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases

Surgery of the upper aerodigestive tract

Details

Title: Subtitle: Recovery of cognitive function after surgery for aneurysmal subarachnoid hemorrhage
Creators: Satwant K SAMRA - Department of Anesthesiology, University of Michigan Medical Center, Ann Arbor, United States
Bruno GIORDANI - Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, United States
Angela F CAVENEY - Department of Psychiatry, University of Michigan Medical Center, Ann Arbor, United States
William R CLARKE - Department of Biostatistics and Clinical Trials Data Management Center in the College of Public Health, University of Iowa Carver College of Medicine, Iowa City, United States
Phillip A SCOTT - Department of Emergency Medicine, University of Michigan Medical Center, Ann Arbor, United States
Steven ANDERSON - Department of Neurology, University of Iowa Carver College of Medicine, Iowa City, United States
Byron G THOMPSON - Department of Neurosurgery, University of Michigan Medical Center, Ann Arbor, United States
Michael M TODD - Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, United States
Resource Type: Journal article
Publication Details: Stroke (1970), Vol.38(6), pp.1864-1872
DOI: 10.1161/STROKEAHA.106.477448
PMID: 17431208
NLM abbreviation: Stroke
ISSN: 0039-2499
eISSN: 1524-4628
Publisher: Lippincott Williams & Wilkins; Hagerstown, MD
Language: English
Date published: 2007
Academic Unit: Neurology; Anesthesia
Record Identifier: 9984020727502771

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