Dey Subir, Kumar J Keshav, Shukla Dhaval, Bhat Dhananjaya
Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Neurol India. 2018 Nov-Dec;66(6):1713-1717. doi: 10.4103/0028-3886.246243.
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.
关于哪些损伤（认知或神经方面）决定动脉瘤性蛛网膜下腔出血（SAH）后的功能结局，目前信息匮乏。本研究旨在确定上述每种损伤对SAH后功能结局的相对贡献。
这是一项前瞻性观察性研究，纳入动脉瘤性SAH患者。患者出院后6个月接受评估，分别使用美国国立卫生与社会科学研究所（NIHSS）评分、国立精神卫生和神经科学研究所（NIMHANS）神经心理学测试套件以及格拉斯哥扩展预后量表（GOSE）评估神经功能缺损、认知障碍和功能结局。使用Spearman等级相关系数分析GOSE与NIHSS评分及神经心理学测试评分之间的相关性。
56例患者使用NIHSS、神经心理学测试和GOSE这三种工具进行了评估。51名健康志愿者参与了神经学检查和神经心理学评估研究。6个月时，与对照组相比，SAH患者存在明显的认知障碍。NIHSS评分的平均值为10.01±9.04，表明为中度严重损伤。6个月时GOSE的中位数为6（范围：3 - 8），表明为中度残疾的上限。NIHSS评分与GOSE存在显著相关性，Spearman等级相关系数为 -0.653（<0.001）。神经心理学测试评分与GOSE和NIHSS均存在显著相关性。NIHSS与GOSE的Spearman等级相关系数处于神经心理学评分与GOSE的范围内。
神经功能缺损和认知障碍均决定SAH后6个月的功能结局。
