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Loss of Consciousness at SAH Onset Indicates Early Brain Injury

LOC at onset of subarachnoid hemorrhage linked to death or severe disability at 12 months

WEDNESDAY, Nov. 11, 2015 (HealthDay News) — Loss of consciousness (LOC) at subarachnoid hemorrhage (SAH) onset is associated with worse prognosis, according to a study published online Nov. 9 in JAMA Neurology.

Sureerat Suwatcharangkoon, M.D., from the Columbia University Medical Center in New York City, and colleagues conducted a retrospective analysis involving 1,460 patients with spontaneous SAH. Structured interviews with the patients and first responders were conducted to identify LOC. Functional recovery was assessed in 80.5 percent of patients who were observed for up to one year.

The researchers found that 40.4 percent of patients reported LOC at SAH onset. LOC correlated with poor clinical grade, more subarachnoid and intraventricular blood seen on admission computed tomographic scan, and increased frequency of global cerebral edema (P < 0.001). Compared with patients who did not experience LOC, those with LOC had more prehospital tonic-clonic activity (22.7 versus 4.2 percent) and cardiopulmonary arrest (9.7 versus 0.5 percent) (both P < 0.001). After adjustment for established risk factors for poor outcome, including poor admission clinical grade, death or severe disability at 12 months was independently associated with LOC in multivariable analysis (adjusted odds ratio, 1.94; P < 0.001).

“Loss of consciousness at symptom onset is an important manifestation of early brain injury after SAH and a predictor of death or poor functional outcome at 12 months,” the authors write.

One author disclosed financial ties to the pharmaceutical industry.

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