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Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations

  • Clinical Article - Vascular
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Abstract

Background

In a high proportion of patients with favorable outcome after aneurysmal subarachnoid hemorrhage (aSAH), neuropsychological deficits, depression, anxiety, and fatigue are responsible for the inability to return to their regular premorbid life and pursue their professional careers. These problems often remain unrecognized, as no recommendations concerning a standardized comprehensive assessment have yet found entry into clinical routines.

Methods

To establish a nationwide standard concerning a comprehensive assessment after aSAH, representatives of all neuropsychological and neurosurgical departments of those eight Swiss centers treating acute aSAH have agreed on a common protocol. In addition, a battery of questionnaires and neuropsychological tests was selected, optimally suited to the deficits found most prevalent in aSAH patients that was available in different languages and standardized.

Results

We propose a baseline inpatient neuropsychological screening using the Montreal Cognitive Assessment (MoCA) between days 14 and 28 after aSAH. In an outpatient setting at 3 and 12 months after bleeding, we recommend a neuropsychological examination, testing all relevant domains including attention, speed of information processing, executive functions, verbal and visual learning/memory, language, visuo-perceptual abilities, and premorbid intelligence. In addition, a detailed assessment capturing anxiety, depression, fatigue, symptoms of frontal lobe affection, and quality of life should be performed.

Conclusions

This standardized neuropsychological assessment will lead to a more comprehensive assessment of the patient, facilitate the detection and subsequent treatment of previously unrecognized but relevant impairments, and help to determine the incidence, characteristics, modifiable risk factors, and the clinical course of these impairments after aSAH.

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Conflict of interest

None.

Informed patient consent

Data of patients included in the Swiss SOS study are reported in this work. Written informed consent was obtained from all of these participants. Both local institutional review boards approved the study (Geneva: Autorisation générale Protocole n° 11-233R (NAC 11-085R); St.Gallen: EKSG 12/016/1B).

Financial disclosure

There was no funding received for this work.

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Authors and Affiliations

  1. Division of Neuropaediatrics, Development, and Rehabilitation, Department of Paediatrics, Inselspital Bern, Bern, Switzerland

    Antoinette E. Zweifel-Zehnder

  2. Department of Neurosurgery and Faculty of Medicine, University Hospital Geneva, Geneva, Switzerland

    Martin N. Stienen, Philippe Bijlenga & Karl Schaller

  3. Department of Neurology, Neuropsychology Unit, University Hospital Geneva, Geneva, Switzerland

    Christian Chicherio

  4. Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Aline Studerus-Germann

  5. Memory Clinic, University Center for Medicine of Aging, Felix Platter-Hospital, Basel, Switzerland

    Stefan Bläsi & Andreas U. Monsch

  6. Department of Neurology, Neuropsychology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland

    Stefania Rossi & Leonardo Sacco

  7. Division of Cognitive and Restorative Neurology, Department of Neurology, Inselspital Bern, Bern, Switzerland

    Klemens Gutbrod & Rene Müri

  8. Neuropsychology Unit, Department of Neurology, Kantonsspital Aarau, Aarau, Switzerland

    Nicole Schmid

  9. Neuropsychology Unit, Clinical Neurosciences Department, CHUV, Lausanne, Switzerland

    Valérie Beaud

  10. Neurological Rehabilitation, Rehaklinik Bellikon, Bellikon, Switzerland

    Christian Mondadori

  11. Neuropsychology Unit, Department of Neurology, University Hospital Zürich, Zürich, Switzerland

    Peter Brugger

  12. Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland

    Gerhard Hildebrandt & Jean-Yves Fournier

  13. Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland

    Emanuela Keller & Luca Regli

  14. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Javier Fandino

  15. Department of Neurosurgery, University Hospital Basel, Basel, Switzerland

    Luigi Mariani

  16. Department of Neurosurgery, Inselspital Bern, Bern, Switzerland

    Andreas Raabe

  17. Department of Neurosurgery, CHUV, Lausanne, Switzerland

    Roy Thomas Daniel

  18. Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland

    Michael Reinert & Thomas Robert

  19. Department of Neurosurgery, Georg-August University, University Medicine Göttingen, Göttingen, Germany

    Bawarjan Schatlo

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  1. Antoinette E. Zweifel-Zehnder
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  2. Martin N. Stienen
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  3. Christian Chicherio
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  4. Aline Studerus-Germann
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  5. Stefan Bläsi
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  7. Klemens Gutbrod
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  8. Nicole Schmid
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  9. Valérie Beaud
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  10. Christian Mondadori
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Consortia

on behalf of the Swiss SOS study group

Corresponding author

Correspondence to Martin N. Stienen.

Additional information

Presentation at congresses: The recommendations have been submitted as an abstract to the annual meeting of the Swiss Society of Neurosurgery, as well as for the Vasospasm congress 2015.

Members and their affiliations are listed in the appendix

Antoinette E. Zweifel-Zehnder and Martin N. Stienen contributed equally to the manuscript and should thus be regarded as first authors

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Table 1

(DOCX 61 kb)

Supplementary Table 2

(DOCX 55 kb)

Appendix

Appendix

Further Swiss SOS contributors are listed below:

Ali-Reza Fathi, Serge Marbacher, Hassen Kerkeni, Jehuda Soleman, Daniel Coluccia, Carl Muroi, Hiroki Danura – Department of Neurosurgery, Kantonsspital Aarau, Switzerland

Jan-Karl Burkhardt, Oliver Bozinov – Department of Neurosurgery/Neurointensive Care Unit, University Hospital of Zurich, Zurich, Switzerland

David Bervini, Rodolfo Maduri, Marc Levivier – Department of Neurosurgery, Lausanne University Hospital, Lausanne, Switzerland

Andrea Ferrari, Martin Seule – Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland

Michel Röthlisberger, Daniel Zumofen, Raphael Guzman – Department of Neurosurgery, Basel University Hospital, Basel, Switzerland

Daniel Schöni, Christian Fung, Jürgen Beck, Philippe Schucht – Department of Neurosurgery (2a) Department of Intensive Care Medicine, Inselspital, Bern, Switzerland

Daniele Valsecchi, Marta Arrighi, Dominque Emmanuelle Kuhlen – Department of Neurosurgery, Ospedale Regionale di Lugano, Lugano, Switzerland

Marco V. Corniola – Department of Neurosurgery, University Hospital Geneva, Geneva, Switzerland

Severin Früh – Neuropsychology Unit, Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland

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Zweifel-Zehnder, A.E., Stienen, M.N., Chicherio, C. et al. Call for uniform neuropsychological assessment after aneurysmal subarachnoid hemorrhage: Swiss recommendations. Acta Neurochir 157, 1449–1458 (2015). https://doi.org/10.1007/s00701-015-2480-y

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