Journal Reading

Loss of Consciousness at Onset of

Subarachnoid Hemorrhage
as an Important Marker of Early
Brain Injury
Hidayaturrahmi
Pembimbing : Dr. dr. Imran, M.Kes, Sp.S
Moderator : dr. Nur Astini, Sp.S
Komentator : dr. M. Isra Ikhwana
 OBJECTIVE

• To clarify the association between Loss Of

Consciousness (LOC) at onset of SAH,
complications while in the hospital, and
long-term outcome after SAH.
 Methods
Clinical Management
Analysis from -Nimodipine 60 mg/4
- 1482 patients with - Retrospectively 2013 - 2015 
analyzed hours
SAH*  1460 Logistic
pasient - between August 6, regression  P < -Maintain euvolemia
- SHOP** 1996, and July 23, 0.01  R -Systolic blood
2012 statistical pressure between 180
software and 220 mm Hg

*SAH  Head CT scan or by xanthochromia in the cerebrospinal fluid

**The Columbia University SAH Outcomes Project (SHOP) at Columbia Presbyterian Hospital
Excluded  SAHt and AVM, <18 Yo, >14 days after onset SAH
 HOSPITAL OUTCOME Radiologic Aneurysm
LOC COMPLICATIONS ASSESSMENT Assessment treatment

Delayed
neurologic
GCS deterioration  2-
point or more Modified Rankin
Global
Cerebral
Clipped
decrease from GCS Scale (mRS) Edema 
scores  CT scan
Delayed cerebral discharge and
ischemia  new
Hunt and focal deficit 12 m
Hess Grade decrease LOC Coiled
Aneurysm
rebleeding  CT Aneurysm
scan
 Days to
APACHE 4-6 Angiography
II New Infarc  repair
CT scan poor procedure
n = 1460
Loss Of Consciousness (LOC)
GCE
 CONCLUSSION

• LOC at onset is associated with a 2.8-fold increase in the

risk of poor outcome after SAH
• LOC  clinically important marker of early brain injury
after SAH
TERIMA KASIH
Global cerebral edema
Lokasi Aneurysma
Aneurysm
Delay Cerebral Ischemia