Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, 66421, Homburg, Saar, Germany.
Department of Neurosurgery, Geisinger Health System, Danville, PA, USA.
Neurosurg Rev. 2020 Aug;43(4):1173-1178. doi: 10.1007/s10143-019-01142-z. Epub 2019 Jul 22.
Loss of consciousness (LOC) at presentation with aneurysmal subarachnoid hemorrhage (aSAH) has been associated with early brain injury and poor functional outcome. The impact of LOC on the clinical course after aSAH deserves further exploration. A retrospective analysis of 149 aSAH patients who were prospectively enrolled in the Cerebral Aneurysm Renin Angiotensin Study (CARAS) between 2012 and 2015 was performed. The impact of LOC was analyzed with emphasis on patients presenting in excellent or good neurological condition (Hunt and Hess 1 and 2). A total of 50/149 aSAH patients (33.6%) experienced LOC at presentation. Loss of consciousness was associated with severity of neurological condition upon admission (Hunt and Hess, World Federation of Neurosurgical Societies (WFNS), Glasgow Coma Scale (GCS) grade), hemorrhage burden on initial head CT (Fisher CT grade), acute hydrocephalus, cardiac instability, and nosocomial infection. Of Hunt and Hess grade 1 and 2 patients, 21/84 (25.0%) suffered LOC at presentation. Cardiac instability and nosocomial infection were significantly more frequent in these patients. In multivariable analysis, LOC was the predominant predictor of cardiac instability and nosocomial infection. Loss of consciousness at presentation with aSAH is associated with an increased rate of complications, even in good-grade patients. The presence of LOC may identify good-grade patients at risk for complications such as cardiac instability and nosocomial infection.
意识丧失（LOC）在蛛网膜下腔出血（aSAH）的表现与早期脑损伤和不良功能预后有关。LOC 对 aSAH 后临床病程的影响值得进一步探讨。对 2012 年至 2015 年期间前瞻性纳入大脑动脉瘤肾素血管紧张素研究（CARAS）的 149 例 aSAH 患者进行了回顾性分析。重点分析了 LOC 对表现出良好或良好神经状态的患者（Hunt 和 Hess 1 级和 2 级）的影响。共有 50/149 例 aSAH 患者（33.6%）在发病时出现 LOC。意识丧失与入院时神经状况的严重程度相关（Hunt 和 Hess、世界神经外科学会联合会（WFNS）、格拉斯哥昏迷量表（GCS）评分）、初始头部 CT 的出血负荷（Fisher CT 分级）、急性脑积水、心脏不稳定和院内感染。在 Hunt 和 Hess 1 级和 2 级患者中，21/84（25.0%）在发病时出现 LOC。这些患者的心脏不稳定和院内感染发生率明显更高。多变量分析显示，LOC 是心脏不稳定和院内感染的主要预测因素。即使在良好分级的患者中，aSAH 发病时的意识丧失也与并发症发生率增加相关。LOC 的存在可能会识别出心脏不稳定和院内感染等并发症风险较高的良好分级患者。
