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


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.

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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.

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Correspondence to Philipp Hendrix.

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Hendrix, P., Foreman, P.M., Senger, S. et al. Loss of consciousness at onset of aneurysmal subarachnoid hemorrhage in good-grade patients. Neurosurg Rev 43, 1173–1178 (2020). https://doi.org/10.1007/s10143-019-01142-z

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  • Loss of consciousness
  • Subarachnoid hemorrhage
  • Aneurysm