Neurological outcome, mental fatigue and occurrence of aneurysms more than 15 years after aneurysmal subarachnoid haemorrhage

Your definition of good is NOT what your survivors would say. I would suggest listening to survivors you might then do the right thing.

Neurological outcome, mental fatigue and occurrence of aneurysms more than 15 years after aneurysmal subarachnoid haemorrhage

Author links open overlay panelJenniferSamuelsson¹²

HugoJakobsson¹AlexandrosRentzos³⁴Asgeir S.Jakola¹²DanielNilsson¹²

¹

Institute of neurosciences and Physiology, Sahlgrenska Academy, Gothenburg University, Sweden

²

Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden

³

Department of Diagnostic and interventional neuroradiology, Sahlgrenska University Hospital, Gothenburg, Sweden

⁴

Department of Radiology, Institute of clinical sciences, University of Gothenburg, Sweden

Received 1 December 2020, Revised 28 March 2021, Accepted 29 March 2021, Available online 5 April 2021.

https://doi.org/10.1016/j.wneu.2021.03.148Get rights and content

Objectives

Long-term data on neurological and radiological outcome after aneurysmal subarachnoid haemorrhage (aSAH) is scarce. The aims of this study were to report neurological and radiological outcome more than 15 years after aSAH.

Patients and methods

Patients from Western Sweden with aSAH randomized to endovascular (EVT) or microsurgical treatment (MST) from 1997 to 2001 were included. Main end-points were neurological outcome assessed by modified Rankin scale (mRS), fatigue assessed by mental fatigue scale (MFS) and radiological outcome assessed by magnetic resonance angiography (MRA). Results were compared to a control group for MFS.

Results

Forty-six patients (62.2%) of the 74 survivors replied after 15-21 years. Eighteen had MST and 28 had EVT. mRS 0-2 was found in 100% of EVT patients and in 88.8 % of MST patients. Moderate or severe mental fatigue was found in 7/28 patients (25 %) in the EVT group and 7/18 patients (38.8 % (p<0.05)) in the MST group, whereas moderate or severe mental fatigue was observed in 3/34 (8.9 %) in the control group. Twenty-nine patients agreed to do an MRA. In the EVT group, new neck remnants were found in 2/16 (12.5%) and de novo aneurysm was found in 2/16 (12.5%). In the MST group de novo aneurysm was found in 1/13 (7.7%).

Conclusions

Neurological outcome at long-term follow-up after aSAH was good, however mental fatigue was overrepresented compared to healthy controls, regardless of treatment modality. Residual or de novo aneurysm was found in 17% of patients warranting radiological long-term follow-up.