Introduction: Patients who suffer aneurysmal subarachnoid hemorrhage (aSAH) are at risk for poor cognitive outcomes. Chronic hydrocephalus may increase this risk, though limited data exists on the relationship between the need for permanent CSF diversion and cognitive performance post-aSAH. The objective of this work was to ascertain whether chronic hydrocephalus was predictive of worse cognitive performance among individuals who survived their hospital stay for aSAH.
Methods: We performed a post-hoc analysis of the Nimodipine Microparticles to Enhance Recovery While Reducing Toxicity After Subarachnoid Hemorrhage (NEWTON-2) clinical trial. All trial participants required placement of an external ventricular drain. Patients that survived to long-term follow-up (90 days) underwent a Montreal Cognitive Assessment (MoCA). We considered individuals to have developed chronic hydrocephalus if they required placement of a permanent shunt. We included age, sex, and WFNS scores in multiple linear regression model to assess for a relationship between MoCA scores and shunt placement.
Results: Of the 289 randomized patients, 215 completed their long term MoCA testing. The median MoCA score was 25 with an interquartile range of 8. Patients requiring permanent shunts scored an average of 3 points lower on their MoCA after controlling for age, sex, and WFNS grade ( = -3.17, s.e. = 0.98, p = 0.001).
Conclusion : We observed that individuals requiring permanent CSF diversion after aSAH are at risk for worse cognitive performance after hospital discharge. This may influence their ability to return to their baseline level of function.
