====== Subarachnoid hemorrhage outcome ======

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see also [[Aneurysmal subarachnoid hemorrhage prognosis]].
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[[QT interval prolongation]] is associated with worse [[subarachnoid hemorrhage]] [[outcome]], which is independent of perioperative cardiac events
((Zhang X, Lei Y, Nan L, Dong S, Liu Y, Yu J, Xu K, Hou K, Ma H. QTc prolongation after aneurysmal subarachnoid hemorrhage might be associated with worse neurologic outcome in patients receiving microsurgical clipping or embolization of the intracranial aneurysms: a retrospective observational study. BMC Neurol. 2024 May 23;24(1):170. doi: 10.1186/s12883-024-03679-z. PMID: 38783204; PMCID: PMC11112891.))
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Approximately 70% of patients with [[subarachnoid hemorrhage]] develop vasospasm; up to 40% experience secondary [[infarction]], part of these without [[vasospasm]]. [[Vasospasm treatment]] in the large cerebral arteries did not improve mortality or functional outcomes
((Macdonald  RL, Higashida  RT, Keller  E,  et al.  Clazosentan, an endothelin receptor antagonist, in patients with aneurysmal subarachnoid haemorrhage undergoing surgical clipping: a randomised, double-blind, placebo-controlled phase 3 trial (CONSCIOUS-2).   Lancet Neurol. 2011;10(7):618-625. doi:10.1016/S1474-4422(11)70108-9))
((Macdonald  RL, Higashida  RT, Keller  E,  et al.  Randomized trial of clazosentan in patients with aneurysmal subarachnoid hemorrhage undergoing endovascular coiling.   Stroke. 2012;43(6):1463-1469. doi:10.1161/STROKEAHA.111.648980)).

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The presence of widespread hemorrhage, hydrocephalus, hematoma and ischaemia on the initial CT scan is associated with poor neurological outcome
((House RJ, Knuckey NW. Early computerized tomographic scan and neurological assessment in subarachnoid hemorrhage. Med J Aust. 1980 May 3;1(9):435-6. doi: 10.5694/j.1326-5377.1980.tb135004.x. PMID: 7393096.)).
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A study evaluated [[microRNA]] ([[MicroRNA]]) changes in [[cerebrospinal fluid]] (CSF) and their association with the occurrence of [[delayed cerebral ischemia]] (DCI) and poor functional [[subarachnoid hemorrhage]] [[outcome]].

Forty-three selected MicroRNAs were measured in daily CSF samples from a discovery cohort of SAH patients admitted to Rigshospitalet, [[Copenhagen]], [[Denmark]], and compared with neurologically healthy patients. Findings were validated in [[CSF]] from a replication [[cohort]] of SAH patients admitted to [[Massachusetts General Hospital]], Boston, Massachusetts. The CSF levels of MicroRNA over time were compared with the occurrence of [[DCI]], and functional outcome after 3 months. [[MicroRNA]]s were quantified in 427 CSF samples from 63 SAH patients in the discovery cohort, in 104 CSF samples from 63 SAH patients in the replication cohort, and in 11 CSF samples from 11 neurologically healthy patients. The MicroRNA profile changed remarkably immediately after SAH. Elevated [[miR 9]]-3p was associated with a poor functional outcome in the discovery cohort (p < 0.0001) after correction for multiple testing (q < 0.01) and in the replication cohort (p < 0.01). Furthermore, elevated miR-9-5p was associated with a poor functional outcome in the discovery cohort (p < 0.01) after correction for multiple testing (q < 0.05). No MicroRNA was associated with DCI in both cohorts. miR-9-3p and miR-9-5p are elevated in the CSF following SAH and this elevation is associated with a poor functional outcome. These elevations have potential roles in the progression of cerebral injury and could add to early prognostication
((Bache S, Rasmussen R, Wolcott Z, Rossing M, Møgelvang R, Tolnai D, Hassager C,
Forman JL, Køber L, Nielsen FC, Kimberly WT, Møller K. Elevated miR-9 in
Cerebrospinal Fluid Is Associated with Poor Functional Outcome After Subarachnoid
Hemorrhage. Transl Stroke Res. 2020 Apr 4. doi: 10.1007/s12975-020-00793-1. [Epub
ahead of print] PubMed PMID: 32248435.
)).
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Mental [[fatigue]] after [[SAH]] is a serious burden to the [[patient]] and is associated with impaired long-term functional [[outcome]]. Distinguishing different aspects of fatigue is relevant as mental post-SAH fatigue might be a target for treatment aimed to improve long-term outcome
((Buunk AM, Groen RJM, Wijbenga RA, Ziengs AL, Metzemaekers JDM, van Dijk JMC,
Spikman JM. Mental versus physical fatigue after subarachnoid hemorrhage:
differential associations with outcome. Eur J Neurol. 2018 Jun 20. doi:
10.1111/ene.13723. [Epub ahead of print] PubMed PMID: 29924481.
)).