Loss of consciousness at onset of aneurysmal subarachnoid hemorrhage in good-grade patients

  • Philipp HendrixEmail author
  • Paul M. Foreman
  • Sebastian Senger
  • Benedikt W. Burkhardt
  • Mark R. Harrigan
  • Winfield S. Fisher3rd
  • Nilesh A. Vyas
  • Robert H. Lipsky
  • Beverly C. Walters
  • R. Shane Tubbs
  • Mohammadali M. Shoja
  • Christoph J. Griessenauer
Original Article


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.


Loss of consciousness Subarachnoid hemorrhage Aneurysm 



We would like to thank the participants in this study and the efforts of the neurosurgical research coordinators at Inova Health System for their work and contribution to the CARAS Study.


We would like to thank the Department of Anesthesiology at the University of Alabama at Birmingham, the Brain Aneurysm Foundation, and family of Timothy P. Susco for their generous support of the present study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review boards at both institutions and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study at both institutions.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Philipp Hendrix
    • 1
    Email author
  • Paul M. Foreman
    • 2
  • Sebastian Senger
    • 1
  • Benedikt W. Burkhardt
    • 1
  • Mark R. Harrigan
    • 3
  • Winfield S. Fisher3rd
    • 3
  • Nilesh A. Vyas
    • 4
  • Robert H. Lipsky
    • 4
    • 5
  • Beverly C. Walters
    • 3
    • 4
    • 5
  • R. Shane Tubbs
    • 6
  • Mohammadali M. Shoja
    • 7
  • Christoph J. Griessenauer
    • 2
    • 8
  1. 1.Department of NeurosurgerySaarland University Medical Center and Saarland University Faculty of MedicineHomburgGermany
  2. 2.Department of NeurosurgeryGeisinger Health SystemDanvilleUSA
  3. 3.Department of NeurosurgeryUniversity of AlabamaBirminghamUSA
  4. 4.Department of NeurosciencesInova Health SystemFalls ChurchUSA
  5. 5.Department of Molecular NeuroscienceGeorge Mason UniversityFairfaxUSA
  6. 6.Seattle Science FoundationSeattleUSA
  7. 7.Department of SurgeryUniversity of Texas Medical BranchGalvestonUSA
  8. 8.Research Institute of NeurointerventionParacelsus Medical UniversitySalzburgAustria

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