Long-Term Follow-Up of Anterior Pituitary Deficiency after Aneurysmal Subarachnoid Hemorrhage: Prospective Cohort.

OBJECTIVE: The aim of this study was to evaluate the prevalence of hypopituitarism in the acute stage after aneurysmal subarachnoid hemorrhage (SAH) as well at the chronic stage, at least 1 year after bleeding, to assess its implications and correlation with clinical features of the studied population. PATIENTS AND METHODS: This was a prospective cohort study that evaluated patients admitted between December 2009 and May 2011 with a diagnosis of SAH secondary to cerebral aneurysm rupture. Clinical and endocrine assessment was performed during the acute stage after hospital admission and before treatment at a mean of 7.5 days (SD ± 3.8) following SAH, and also at the follow-up visit at a mean of 25.5 months (range: 12-55 months) after the bleeding. RESULTS: Out of the 119 patients initially assessed, 92 were enrolled for acute stage, 82 underwent hormonal levels analysis, and 68 (82.9%) were followed up in both acute and chronic phases. The mean age and median age were lower among patients with dysfunction in the acute phase compared to those without dysfunction (P < .05). The prevalence of dysfunction in the acute phase was higher among patients with hydrocephalus on admission computed tomography (57.9%) than among those without it (P < .05). At chronic phase, there was an association between dysfunction and Hunt & Hess scale score greater than 2 (P < .05). CONCLUSIONS: We believe that there is not enough literature evidence to incorporate routine endocrinological evaluation for patient victims of SAH, but we should always keep this differential diagnosis in mind when conducting long-term assessments of this population.

Prevalence of Cognitive Impairments in Patients with Good Functional Outcome in Late Phase Subarachnoid Hemorrhage / Prevalência de alterações cognitivas em pacientes com bom desfecho funcional na fase tardia da hemorragia subaracnóidea

Prior studies have shown high prevalence of neuropsychological deficits after aneurysmal subarachnoid hemorrhage; however, few studies detect cognitive impairments in patients with good functional outcome, measured whith Rankin Modified Scale, in the late phase of subarachnoid hemorrhage. We confirmed a high prevalence of alterations in neuropsychological tests in 44 patients with Rankin Modified 2.We proposed the application of simple and fast tests that allowed us to detect impairments with precision similar to that of complex cognitive batteries used in previous studies. We also attempt to confirm statistical association between factors that could be related to poor cognitive outcome, like Hunt-Hess scale classification, bleeding intensity measured with Fisher scale, therapeutic type (microsurgery ou embolization), and aneurysm localization; however, there was no significance.

Estudos anteriores mostraram que a prevalência de déficits neuropsicológicos após hemorragia subaracnóide aneurismática é alto,mas poucos estudos detectaram alterações cognitiva sem pacientes com bom desfecho funcional,medido através da escada de Rankin Modificada, na fase tardia da hemorragia subaracnóide. O estudo confirmou em 44 pacientes com RankiN Modificado 2 a alta prevalência de alterações em testes neuropsicológicos. Propusemos a aplicação de testes simples e rápidos, capazes de detectar alterações, com precisão semelhante a baterias cognitivas complexas utilizadas em estudos anteriores.Nós também avaliamos a associação estatística entre alguns fatores como a escala de Hunt-Hess (HH), a intensidade do sangramento pela escala de Fisher, tipo de tratamento (microcirurgia ou embolização) e localização do aneurisma, ao pior desempenho cognitivo, no entanto não houve significância.