Focal Neurological Deficit at Onset of Aneurysmal Subarachnoid Hemorrhage: Frequency and Causes

Réza Behrouz, Lee A. Birnbaum, Pearl M. Jones, Christopher Hans Topel, Vivek Misra, Alejandro Rabinstein

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background and Aim Focal neurological deficit (FND) is a recognized presenting symptom of aneurysmal subarachnoid hemorrhage (SAH). However, little is known on how often aneurysmal SAH patients present with FND and what the responsible mechanisms are. The aim of this study was to examine the frequency and causes of FND at onset in aneurysmal SAH. Methods We reviewed the records of consecutive aneurysmal SAH patients over 5 years and identified those who presented with FND. We developed several potential mechanisms for FND based on consensus between 2 separate evaluating neurologists. We then compared the characteristics of aneurysmal SAH patients who presented with and without FND. Logistic regression models were used to assess for association of FND with poor outcome. Results Of a total of 213 patients, 10.3% presented with FND. The junction of the internal carotid and posterior communicating arteries was the most common aneurysm location in patients with FND (36.4%). Causes of FND at presentation were intraparenchymal hematoma in 45.5%, early cerebral infarction in 22.7%, parenchymal compression by subarachnoid thrombus in 18.2%, and seizure with Todd's paralysis in 13.6%. Patients with FND were older (P = .001) and had higher rates of in-hospital death and severe disability at discharge (P < .0001), compared to those without focal deficit. FND was independently associated with poor outcome (odds ratio: 4.62, confidence interval: 1.41-15.14; P = .01). Conclusion One in every 10 aneurysmal SAH patients presents with FND. FND at presentation has diverse mechanisms, is not associated with a specific aneurysm location, and is independently associated with poor outcome.

Original languageEnglish (US)
Pages (from-to)2644-2647
Number of pages4
JournalJournal of Stroke and Cerebrovascular Diseases
Volume25
Issue number11
DOIs
StatePublished - Nov 1 2016

Fingerprint

Subarachnoid Hemorrhage
Aneurysm
Logistic Models
Cerebral Infarction
Paralysis
Hematoma
Seizures
Thrombosis
Arteries
Odds Ratio
Confidence Intervals

Keywords

  • focal deficit
  • outcome
  • Subarachnoid hemorrhage
  • symptoms

ASJC Scopus subject areas

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Focal Neurological Deficit at Onset of Aneurysmal Subarachnoid Hemorrhage : Frequency and Causes. / Behrouz, Réza; Birnbaum, Lee A.; Jones, Pearl M.; Topel, Christopher Hans; Misra, Vivek; Rabinstein, Alejandro.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 25, No. 11, 01.11.2016, p. 2644-2647.

Research output: Contribution to journalArticle

Behrouz, Réza ; Birnbaum, Lee A. ; Jones, Pearl M. ; Topel, Christopher Hans ; Misra, Vivek ; Rabinstein, Alejandro. / Focal Neurological Deficit at Onset of Aneurysmal Subarachnoid Hemorrhage : Frequency and Causes. In: Journal of Stroke and Cerebrovascular Diseases. 2016 ; Vol. 25, No. 11. pp. 2644-2647.
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abstract = "Background and Aim Focal neurological deficit (FND) is a recognized presenting symptom of aneurysmal subarachnoid hemorrhage (SAH). However, little is known on how often aneurysmal SAH patients present with FND and what the responsible mechanisms are. The aim of this study was to examine the frequency and causes of FND at onset in aneurysmal SAH. Methods We reviewed the records of consecutive aneurysmal SAH patients over 5 years and identified those who presented with FND. We developed several potential mechanisms for FND based on consensus between 2 separate evaluating neurologists. We then compared the characteristics of aneurysmal SAH patients who presented with and without FND. Logistic regression models were used to assess for association of FND with poor outcome. Results Of a total of 213 patients, 10.3{\%} presented with FND. The junction of the internal carotid and posterior communicating arteries was the most common aneurysm location in patients with FND (36.4{\%}). Causes of FND at presentation were intraparenchymal hematoma in 45.5{\%}, early cerebral infarction in 22.7{\%}, parenchymal compression by subarachnoid thrombus in 18.2{\%}, and seizure with Todd's paralysis in 13.6{\%}. Patients with FND were older (P = .001) and had higher rates of in-hospital death and severe disability at discharge (P < .0001), compared to those without focal deficit. FND was independently associated with poor outcome (odds ratio: 4.62, confidence interval: 1.41-15.14; P = .01). Conclusion One in every 10 aneurysmal SAH patients presents with FND. FND at presentation has diverse mechanisms, is not associated with a specific aneurysm location, and is independently associated with poor outcome.",
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T1 - Focal Neurological Deficit at Onset of Aneurysmal Subarachnoid Hemorrhage

T2 - Frequency and Causes

AU - Behrouz, Réza

AU - Birnbaum, Lee A.

AU - Jones, Pearl M.

AU - Topel, Christopher Hans

AU - Misra, Vivek

AU - Rabinstein, Alejandro

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N2 - Background and Aim Focal neurological deficit (FND) is a recognized presenting symptom of aneurysmal subarachnoid hemorrhage (SAH). However, little is known on how often aneurysmal SAH patients present with FND and what the responsible mechanisms are. The aim of this study was to examine the frequency and causes of FND at onset in aneurysmal SAH. Methods We reviewed the records of consecutive aneurysmal SAH patients over 5 years and identified those who presented with FND. We developed several potential mechanisms for FND based on consensus between 2 separate evaluating neurologists. We then compared the characteristics of aneurysmal SAH patients who presented with and without FND. Logistic regression models were used to assess for association of FND with poor outcome. Results Of a total of 213 patients, 10.3% presented with FND. The junction of the internal carotid and posterior communicating arteries was the most common aneurysm location in patients with FND (36.4%). Causes of FND at presentation were intraparenchymal hematoma in 45.5%, early cerebral infarction in 22.7%, parenchymal compression by subarachnoid thrombus in 18.2%, and seizure with Todd's paralysis in 13.6%. Patients with FND were older (P = .001) and had higher rates of in-hospital death and severe disability at discharge (P < .0001), compared to those without focal deficit. FND was independently associated with poor outcome (odds ratio: 4.62, confidence interval: 1.41-15.14; P = .01). Conclusion One in every 10 aneurysmal SAH patients presents with FND. FND at presentation has diverse mechanisms, is not associated with a specific aneurysm location, and is independently associated with poor outcome.

AB - Background and Aim Focal neurological deficit (FND) is a recognized presenting symptom of aneurysmal subarachnoid hemorrhage (SAH). However, little is known on how often aneurysmal SAH patients present with FND and what the responsible mechanisms are. The aim of this study was to examine the frequency and causes of FND at onset in aneurysmal SAH. Methods We reviewed the records of consecutive aneurysmal SAH patients over 5 years and identified those who presented with FND. We developed several potential mechanisms for FND based on consensus between 2 separate evaluating neurologists. We then compared the characteristics of aneurysmal SAH patients who presented with and without FND. Logistic regression models were used to assess for association of FND with poor outcome. Results Of a total of 213 patients, 10.3% presented with FND. The junction of the internal carotid and posterior communicating arteries was the most common aneurysm location in patients with FND (36.4%). Causes of FND at presentation were intraparenchymal hematoma in 45.5%, early cerebral infarction in 22.7%, parenchymal compression by subarachnoid thrombus in 18.2%, and seizure with Todd's paralysis in 13.6%. Patients with FND were older (P = .001) and had higher rates of in-hospital death and severe disability at discharge (P < .0001), compared to those without focal deficit. FND was independently associated with poor outcome (odds ratio: 4.62, confidence interval: 1.41-15.14; P = .01). Conclusion One in every 10 aneurysmal SAH patients presents with FND. FND at presentation has diverse mechanisms, is not associated with a specific aneurysm location, and is independently associated with poor outcome.

KW - focal deficit

KW - outcome

KW - Subarachnoid hemorrhage

KW - symptoms

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