Impact of altered consciousness at the time of presentation on the neurological outcome of patients with aneurysmal subarachnoid haemorrhage

Cerebral aneurysms are defined as dilations that occur at weak points along the arterial circulation within the brain. Around 85% of aneurysms are located in the anterior circulation, predominately at junctions or bifurcations along the circle of Willis. Rupture of these aneurysms cause subarachnoid haemorrhage.1

In India, the prevalence of intracranial aneurysm ranges from 0.75% to 10.3%.2

 Patients with high white blood cell count, multiple aneurysms, hypertension, GCS<9, GCS 9-12, modified Fisher grade 3 and 4 and Hunt-Hess grade 3 or more were found to have poor prognosis.3 Cardiac complications associated with aneurysmal subarachnoid haemorrhage include arrhythmia, myocardial infarction and even cardiac arrest. aSAH is also associated with pulmonary oedema, acute respiratory distress, septicaemia and acute renal failure. Rebleeding, delayed cerebral ischemia, seizures and hydrocephalus are examples of neurological complications.4

Reduced alertness, diminished wakefulness, and a decreased awareness of oneself and the environment all characterize impaired consciousness.5 After being admitted, none of the patients with a GCS motor score of 3 or less than 3 were still alive at 12 months according to a single centre retrospective study.6Sodhi et al in their study reported that WFNS grade at presentation as the most important predictor of outcome.7Chiang et al found that the patient’s worst clinical grade is most predictive of outcome, especially when the patient is assessed using the WFNS scale or the GCS.8 There are very few studies from India that have looked into the overall prognosis of aSAH patients especially those with altered consciousness. We hypothesize that patients with aneurysmal subarachnoid haemorrhagepresenting with altered consciousness at the time of hospital admission will have poor neurological outcome as compared to those with preservation of consciousness.

 Hypothesis of the study

Patients with aneurysmal subarachnoid haemorrhage presenting with altered consciousness at the time of hospital admission will have poor neurological outcome as compared to those with preserved consciousness.