Subarachnoid hemorrhage outcome

see also Aneurysmal subarachnoid hemorrhage outcome.

The presence of widespread hemorrhage, hydrocephalus, hematoma and ischaemia on the initial CT scan is associated with poor neurological outcome 1).

A study evaluated microRNA (miRNA) changes in cerebrospinal fluid (CSF) and their association with the occurrence of delayed cerebral ischemia (DCI) and poor functional subarachnoid hemorrhage outcome.

Forty-three selected miRNAs were measured in daily CSF samples from a discovery cohort of SAH patients admitted to Rigshospitalet, Copenhagen, Denmark, and compared with neurologically healthy patients. Findings were validated in CSF from a replication cohort of SAH patients admitted to Massachusetts General Hospital, Boston, Massachusetts. The CSF levels of miRNA over time were compared with the occurrence of DCI, and functional outcome after 3 months. miRNAs were quantified in 427 CSF samples from 63 SAH patients in the discovery cohort, in 104 CSF samples from 63 SAH patients in the replication cohort, and in 11 CSF samples from 11 neurologically healthy patients. The miRNA profile changed remarkably immediately after SAH. Elevated miR 9-3p was associated with a poor functional outcome in the discovery cohort (p < 0.0001) after correction for multiple testing (q < 0.01) and in the replication cohort (p < 0.01). Furthermore, elevated miR-9-5p was associated with a poor functional outcome in the discovery cohort (p < 0.01) after correction for multiple testing (q < 0.05). No miRNA was associated with DCI in both cohorts. miR-9-3p and miR-9-5p are elevated in the CSF following SAH and this elevation is associated with a poor functional outcome. These elevations have potential roles in the progression of cerebral injury and could add to early prognostication 2).

Mental fatigue after SAH is a serious burden to the patient and is associated with impaired long-term functional outcome. Distinguishing different aspects of fatigue is relevant as mental post-SAH fatigue might be a target for treatment aimed to improve long-term outcome 3).

House RJ, Knuckey NW. Early computerized tomographic scan and neurological assessment in subarachnoid hemorrhage. Med J Aust. 1980 May 3;1(9):435-6. doi: 10.5694/j.1326-5377.1980.tb135004.x. PMID: 7393096.
Bache S, Rasmussen R, Wolcott Z, Rossing M, Møgelvang R, Tolnai D, Hassager C, Forman JL, Køber L, Nielsen FC, Kimberly WT, Møller K. Elevated miR-9 in Cerebrospinal Fluid Is Associated with Poor Functional Outcome After Subarachnoid Hemorrhage. Transl Stroke Res. 2020 Apr 4. doi: 10.1007/s12975-020-00793-1. [Epub ahead of print] PubMed PMID: 32248435.
Buunk AM, Groen RJM, Wijbenga RA, Ziengs AL, Metzemaekers JDM, van Dijk JMC, Spikman JM. Mental versus physical fatigue after subarachnoid hemorrhage: differential associations with outcome. Eur J Neurol. 2018 Jun 20. doi: 10.1111/ene.13723. [Epub ahead of print] PubMed PMID: 29924481.
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