Complications and outcome in patients with aneurysmal subarachnoid haemorrhage: a prospective hospital based cohort study in the Netherlands

OBJECTIVE—The aim of this study was to investigate prospectively in an unselected series of patients with an aneurysmal subarachnoid haemorrhage what at present the complications are, what the outcome is, how many of these patients have "modern treatment"—that is, early obliteration of the aneurysm and treatment with calcium antagonists—what factors cause a delay in surgical or endovascular treatment, and what the estimated effect on outcome will be of improved treatment.
METHODS—A prospective, observational cohort study of all patients with aneurysmal subarachnoid haemorrhage in the hospitals of a specified region in The Netherlands. The condition on admission, diagnostic procedures, and treatments were recorded. If a patient had a clinical deterioration, the change in Glasgow coma score (GCS), the presence of focal neurological signs, the results of additional investigations, and the final diagnosed cause of the deterioration were recorded.
 Clinical outcome was assessed with the Glasgow outcome scale (GOS) at 3 month follow up. In patients with poor outcome at follow up, the cause was diagnosed.
RESULTS—Of the 110 patients, 47 (43%) had a poor outcome. Cerebral ischaemia, 31 patients (28%), was the most often occurring complication. Major causes of poor outcome were the effects of the initial haemorrhage and rebleeding in 34% and 30% of the patients with poor outcome respectively. Of all patients 102 (93%) were treated with calcium antagonists and 45 (41%) patients had early treatment to obliterate the aneurysm. The major causes of delay of treatment were a poor condition on admission or deterioration shortly after admission, in 31% and 23% respectively.
CONCLUSIONS—In two thirds of the patients with poor outcome the causes of poor outcome are the effects of the initial bleeding and rebleeding. Improved treatment of delayed or postoperative ischaemia will have only minor effects on the outcome of patients with subarachnoid haemorrhage.


Presenting symptoms and functional outcome of chronic subdural hematoma patients

Background Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. The relationship of these signs and symptoms with functional outcome is unknown. Knowledge of these associations might aid clinicians in the choice to initiate treatment and may allow them to better inform patients on expected outcomes. Objective To investigate if presenting signs and symptoms influence functional outcome in patients with CSDH. Methods We conducted a retrospective analysis of consecutive CSDH patients in three hospitals. Glasgow Outcome Scale Extended (GOS-E) scores were obtained from the first follow-up visit after treatment. An ordinal multivariable regression analysis was performed, to assess the relationship between the different signs and symptoms on the one hand and functional outcome on the other adjusted for potential confounders. Results We included 1,307 patients, of whom 958 (73%) were male and mean age was 74 (SD +/- 11) years. Cognitive complaints were associated with lower GOS-E scores at follow-up (aOR 0.7, 95% CI: 0.5 - 0.8) Headache and higher Glasgow Coma Scale (GCS) scores were associated with higher GOS-E scores. (aOR 1.9, 95% CI: 1.5-2.3 and aOR 1.3, 95% CI: 1.2-1.4). Conclusion Cognitive complaints are independently associated with worse functional outcome, whereas headache and higher GCS scores are associated with better outcome. The increased probability of unfavorable outcome in patients with CSDH who present with cognitive complaints favors a more prominent place of assessing cognitive status at diagnosis.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Prevalence of cognitive complaints and impairment in patients with chronic subdural hematoma and recovery after treatment: a systematic review

Chronic subdural hematoma (CSDH) is a frequently occurring neurological disease associated with older age and use of anticoagulants. Symptoms vary from headaches to coma, but cognitive deficits can also be present. However, exact prevalence and severity of cognitive deficits in CSDH are still unknown. In this systematic review, we aim to assess cognitive status of patients with CSDH, at presentation and after treatment. PubMed, Embase and PsycInfo were searched for articles concerning cognition in CSDH. We divided cognitive changes into subjective cognitive deficit (cognitive complaints [CC]) and objective cognitive deficit (cognitive impairment [CI]). Two reviewers independently selected studies for inclusion and subsequently extracted data. Quality assessment was done by means of the Newcastle-Ottawa Scale. Reported prevalence of CC and CI was pooled with random effects meta-analysis. Out of 799 identified references, 22 met inclusion criteria. Twenty-one articles reported on prevalence of CC/CI and one study reported solely on CSDH patients with cognitive deficit. Estimated pooled prevalence of both CC and CI in CSDH at presentation was 45% (95% confidence interval [CI]: 36-54%). Four studies concerned a prospective evaluation of the effect of surgical treatment on cognition. These proved to be of fair to good quality after quality assessment. The estimated pre-treatment prevalence of objectified cognitive impairment was 61% (95% CI: 51-70%) decreasing to 18% (95% CI: 8-32%) post-surgery. From this review it can be concluded that CC and CI are very common in CSDH, with a tendency to improve after treatment. Therefore, we underline the importance of increased attention to cognitive status of these patients, with proper testing methods and treatment-testing intervals.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

The cognitive status of chronic subdural hematoma patients after treatment: an exploratory study

ObjectiveChronic subdural hematoma (CSDH) is a common neurological condition, often affecting the elderly. Cognitive impairment is frequently observed at presentation. However, the course and longer term aspects of the cognitive status of CSDH patients are unknown. In this study, we aim to explore the cognitive status of CSDH patients after treatment.MethodsAn exploratory study in which CSDH patients were assessed 3 months after treatment and compared to healthy controls. A total of 56 CSDH patients (age 72.1 SD +/- 10.8 years with 43 [77%] males) and 60 healthy controls were included (age 67.5 +/- SD 4.8 with 34 [57%] males). Cognitive testing was performed using the Telephonic Interview of Cognitive Status-modified (TICS-m), a 12-item questionnaire in which a total of 50 points can be obtained on several cognitive domains.ResultsMedian time between treatment and cognitive testing was 93 days (range 76-139). TICS-m scores of CSDH patients were significantly lower than healthy controls, after adjusting for age and sex: mean score 34.6 (95% CI: 33.6-35.9) vs. 39.6 (95% CI: 38.5-40.7), p value < 0.001. More than half (54%) of CSDH patients have cognitive scores at follow-up that correspond with cognitive impairment.ConclusionA large number of CSDH patients show significantly worse cognitive status 3 months after treatment compared to healthy controls. This finding underlines the importance of increased awareness for impaired cognition after CSDH. Further research on this topic is warranted.Scientific Assessment and Innovation in Neurosurgical Treatment Strategie

Dexamethasone therapy versus surgery for chronic subdural haematoma (DECSA trial): study protocol for a randomised controlled trial

Paroxysmal Cerebral Disorder

The spontaneous spinal epidural hematoma. A clinical and anatomical study with correlations to the morphology of the internal vertebral venous plexus

This thesis concerns a clinical study of the spontaneous spinal epidural hematoma (SSEH) and a study of the vascular anatomy of the spinal epidural space. In particular the morphology of the internal vertebral venous plexus is studied, in an attempt to find an explanation for the etiology of this disorder

The development of modern neurosurgery in The Netherlands

This book describes the history of neurosurgery in the Netherlands. Through the study of long-lost archives, much more has become known about the significance of Ignaz Oljenick and his first colleagues. Intrigues, personal ambitions, political agendas, local and regional interests and coincidental circumstances formed the basis for the creation of the eleven neurosurgical clinics at that time. Surprising original insights and scientific contributions are also discussed. Some early players appear to deserve more respect than they are due, while others may lose some of their shine

Algemeenverbindendverklaring

Wanneer private partijen afspraken met elkaar maken, kunnen zij die – onder bepaalde voorwaarden – algemeen verbindend laten verklaren. Zij doen daartoe dan een verzoek aan de betrokken bewindspersoon, die toetst of aan de voorwaarden voor algemeenverbindendverklaring is voldaan. Als dat het geval is en de bewindspersoon tot algemeenverbindendverklaring van de afspraken besluit over te gaan, heeft dat tot gevolg dat eenieder die onder de werkingssfeer van die afspraken valt, erdoor wordt gebonden. Dat geldt dus óók voor degenen die bij het maken van de afspraak niet betrokken waren. Ná de algemeenverbindendverklaring van de afspraken houdt de bemoeienis van de overheid in principe op: uitvoering en handhaving van de afspraken is aan de deelnemers zelf. Dat de afspraken door een minister algemeen verbindend worden verklaard, betekent niet dat de afspraken daarmee een publiekrechtelijk karakter krijgen