Neurological, neuropsychological, and functional outcome after good grade aneurysmal subarachnoid hemorrhage

There is a paucity of information about which impairments, cognitive or neurological, determine the functional outcome after aneurysmal subarachnoid hemorrhage (SAH). The present study aims to determine the relative contributions of each of the above impairments for determining the functional outcome after SAH.

This is a prospective observational study including patients with aneurysmal SAH. Patients underwent assessment at 6 months after discharge for neurological deficits, cognitive impairment, and functional outcome using the National Institute of Health and Social Sciences (NIHSS) score, National Institute of Mental Health and Neurosciences (NIMHANS) Neuropsychology Test Battery, and Glasgow Outcome Scale - Extended (GOSE), respectively. The correlation of GOSE with NIHSS scores and neuropsychological test scores was done using Spearman's rho correlation coefficient.

Fifty-six patients underwent assessment using all the three tools, i.e., NIHSS, neuropsychological tests, and GOSE. Fifty-one healthy volunteers participated in the study for neurological examination and neuropsychological assessment. At 6 months, patients with SAH had significant cognitive impairment as compared to controls. The mean NIHSS score was 10.01 ± 9.04, indicating moderately severe impairment. The median GOSE at 6 months was 6 (range: 3-8) indicating the upper level of moderate disability. There was a significant correlation of NIHSS scores with GOSE, Spearman's rho -0.653 (<0.001). There was a significant correlation of neuropsychological test scores with GOSE and NIHSS. The Spearman's rho for NIHSS vs GOSE was within range for neuropsychological scores vs GOSE.

Both the neurological deficits and cognitive impairment determine functional outcome after SAH at 6 months.