Neuropsychiatric disturbances in acute subarachnoid haemorrhage.
BACKGROUND
Acute and unexpected neuropsychiatric disturbances can herald subarachnoid haemorrhage (SAH). We investigated the risk factors for neuropsychiatric disturbances in acute SAH and analysed the relation between neuropsychiatric disturbances and location and amount of haematic densities and hydrocephalus.


METHODS
We assessed a sample of 108 consecutive patients with an acute (≤ 4 days) SAH (61 aneurysmal, 47 non-aneurysmal SAH), before aneurysmal treatment, using DSM-IV-TR criteria and the Montgomery Åsberg Depression Rating Scale and Mania Rating Scale, the Denial of Illness Scale, the Catastrophic Reaction Scale and the Apathy Evaluation Scale, excluding patients with severe consciousness or language disturbance. Performance on each scale was related to (i) the total amount of haematic densities in 10 basal cisterns/fissures and in the four ventricles, using the Hijdra et al. rating scale, (ii) the haematic densities in the prepontine cistern and the convexity of the brain and (iii) hydrocephalus.


RESULTS
Depression (45%), apathy (42%), denial (21%) and catastrophic reaction (17%) were frequent in acute SAH patients. Mania was present in two patients. Denial was associated with higher haematic densities in the left and right basal sylvian fissure and in the 4th ventricle (P < 0.01) and with hydrocephalus (P = 0.05). Catastrophic reaction and depression were associated with previous mood disorder (P < 0.007). Apathy was associated with blood in the left or right lateral ventricles (P < 0.03).


CONCLUSIONS
In the first 4 days of SAH, depression, apathy, catastrophic reaction and denial were rather frequent. SAH haematic densities were associated with denial and apathy, but not with depression, mania or catastrophic reaction.
Institute of Molecular Medicine and Faculty of Medicine of the University of Lisbon, Lisbon, Portugal. aracaeiro@fm.ul.pt
L
L
Caeiro
C O
CO
Santos
J M
JM
Ferro
M L
ML
Figueira
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity / Q000639:trends; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D019965:Neurocognitive Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D011859:Radiography; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013346:Subarachnoid Space / Q000000981:diagnostic imaging / Q000473:pathology*; D055815:Young Adult