Abstract
Background
In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits, depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional careers. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routines.
Methods
To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was selected, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages and standardized.
Results
We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH. In an outpatient setting at 3 and 12 months after bleeding, we recommend a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence. In addition, a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life should be performed.
Conclusions
This standardized neuropsychological assessment will lead to a more comprehensive assessment of the patient, facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments, and help to determine the incidence, characteristics, modifiable risk factors, and the clinical course of these impairments after aSAH.
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Data of patients included in the Swiss SOS study are reported in this work. Written informed consent was obtained from all of these participants. Both local institutional review boards approved the study (Geneva: Autorisation générale Protocole n° 11-233R (NAC 11-085R); St.Gallen: EKSG 12/016/1B).
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Presentation at congresses: The recommendations have been submitted as an abstract to the annual meeting of the Swiss Society of Neurosurgery, as well as for the Vasospasm congress 2015.
Members and their affiliations are listed in the appendix
Antoinette E. Zweifel-Zehnder and Martin N. Stienen contributed equally to the manuscript and should thus be regarded as first authors
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Appendix
Appendix
Further Swiss SOS contributors are listed below:
Ali-Reza Fathi, Serge Marbacher, Hassen Kerkeni, Jehuda Soleman, Daniel Coluccia, Carl Muroi, Hiroki Danura – Department of Neurosurgery, Kantonsspital Aarau, Switzerland
Jan-Karl Burkhardt, Oliver Bozinov – Department of Neurosurgery/Neurointensive Care Unit, University Hospital of Zurich, Zurich, Switzerland
David Bervini, Rodolfo Maduri, Marc Levivier – Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland
Andrea Ferrari, Martin Seule – Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
Michel Röthlisberger, Daniel Zumofen, Raphael Guzman – Department of Neurosurgery, Basel University Hospital, Basel, Switzerland
Daniel Schöni, Christian Fung, Jürgen Beck, Philippe Schucht – Department of Neurosurgery (2a) Department of Intensive Care Medicine, Inselspital, Bern, Switzerland
Daniele Valsecchi, Marta Arrighi, Dominque Emmanuelle Kuhlen – Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland
Marco V. Corniola – Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland
Severin Früh – Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Zweifel-Zehnder, A.E., Stienen, M.N., Chicherio, C. et al. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir 157, 1449–1458 (2015). https://doi.org/10.1007/s00701-015-2480-y
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DOI: https://doi.org/10.1007/s00701-015-2480-y