Neuro-endocrine and neuropsychological outcome after aneurysmal subarachnoid hemorrhage (aSAH): a prospective cohort study.
OBJECTIVE
Neuropsychological sequelae are common after aneurysmal subarachnoid hemorrhage (aSAH) and may be associated with or caused by supposed hypothalamic-pituitary dysfunction. We evaluated the incidence of neuro-endocrine and neuropsychological deficits after aSAH and their interrelations in a standardized manner.


METHODS
26 patients (20 females) were prospectively screened for neuro-endocrine and neuropsychological deficits 3 and 6 months after aSAH. We measured GH, IGF-1, prolactin, LH, FSH, estradiol, TSH, fT4, total T3, testosterone, ACTH as well as cortisol before and after ACTH-stimulation. Neuropsychological analysis covered verbal comprehension, short term and working memory, visuospatial construction, figural memory, psychomotor speed, attention, and concentration.


RESULTS
After 3 months central hypogonadism was observed in 2 patients accompanied by central hypothyroidism in 1 male subject. Central hypogonadism resolved spontaneously after 6 months in both. After 3 months, neuropsychological deficits were detected in 57% of the examined patients (44% attention deficits, 38% memory impairment, 12% psychomotor deficits). Neuropsychological deficits were still present in 53% after 6 months.


CONCLUSIONS
We found a low prevalence of neuro-endocrine and a high prevalence of neuropsychological deficits in patients 3 and 6 months after aSAH. Thus, the absent co-incidence of central hormonal and psychological dysfunction leaves a causal association questionable.
Lammert
A
A
Vth Department of Medicine, University Medical Center Mannheim, Mannheim, Germany. alexander.lammert@umm.de
Bode
H
H
Hammes
H-P
HP
Birck
R
R
Fatar
M
M
Zohsel
K
K
Braun
J
J
Schmieder
K
K
Diepers
M
M
Schubert
G A
GA
Barth
M
M
Thomé
C
C
Seiz
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004700:Endocrine System Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D008875:Middle Aged; D009490:Neurosecretory Systems / Q000503:physiopathology; D011379:Prognosis; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult