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Loss of Consciousness at Onset of Subarachnoid Hemorrhage as an Important Marker of Early Brain Injury
Abstract
Importance Loss of consciousness (LOC) is a common presenting symptom of subarachnoid hemorrhage (SAH) that is presumed to result from transient intracranial circulatory arrest. Objective To clarify the association between LOC at onset of SAH, complications while in the hospital, and long-term outcome after SAH. Design, setting, and participants A retrospective analysis was conducted of 1460 consecutively treated patients with spontaneous SAH who were part of a prospective observational cohort study at a large urban academic medical center (the Columbia University SAH Outcomes Project or SHOP). Patients were enrolled between August 6, 1996, and July 23, 2012. Analysis was conducted from December 1, 2013, to February 28, 2015. Exposures Loss of consciousness at onset was identified by structured interview of the patient and first responders. Patients (80.5%) were observed for up to 1 year to assess functional recovery. Main outcomes and measures Modified Rankin scale scores were assigned based on telephone or in-person interviews of the patient, family members, or caregivers. Complications while in the hospital were predefined and adjudicated by the study team. Results Five hundred ninety patients (40.4%) reported LOC at onset of SAH. Loss of consciousness was associated with poor clinical grade, more subarachnoid and intraventricular blood seen on admission computed tomographic scan, and a higher frequency of global cerebral edema (P Conclusions and relevance Loss of consciou…
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A prospective study investigating loss of consciousness and subarachnoid hemorrhage found that almost half of the patients who were unconscious for less than 10 min scored 1 or 2 on the Hunt and Hess scale, suggesting these patients had less severe brain damage.
“A prospective study investigating loss of consciousness and subarachnoid hemorrhage found that almost half of the patients who were unconscious for less than 10 min scored 1 or 2 on the Hunt and Hess scale, suggesting these patients had less severe brain damage [67].”
From Head Injury and Amyotrophic Lateral Sclerosis: Population-Based Study from the National ALS Registry (2025) · cites this paper as [67]
Over half of the patients who were unconscious for 10-60 min or more than 60 min scored 4 or higher on the Hunt and Hess scale, demonstrating that the longer a patient is unconscious, the more severe the neurological damage.
“Over half of the patients who were unconscious for 10–60 min or more than 60 min scored 4 or higher on the Hunt and Hess scale, demonstrating that the longer a patient is unconscious, the more severe the neurological damage.”
From Head Injury and Amyotrophic Lateral Sclerosis: Population-Based Study from the National ALS Registry (2025) · cites this paper as [67]
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Head Injury and Amyotrophic Lateral Sclerosis: Population-Based Study from the National ALS Registry
Raymond, J., Howard, I. M., Berry, J., Larson, T., Horton, D. K., & Mehta, P. (2025) · Brain Sciences · doi:10.3390/brainsci15020143 · Cited by 4
Metadata
- Authors
- Suwatcharangkoon, S., Meyers, E., Falo, C., Schmidt, J. M., Agarwal, S., Claassen, J., & Mayer, S. A.
- Affiliations
- Mahidol University (TH)
- Columbia University Irving Medical Center (US)
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2016-01-01
- Volume
- 73
- Issue
- 1
- Pages
- 28
- ISSN
- 2168-6149 (ISSN-L)
- OpenAlex
- W2098594396
- Cited by
- 114
- References
- 0
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 8 · 2023: 10 · 2022: 12 · 2021: 20 · 2020: 16 · 2019: 15 · 2018: 7 · 2017: 3 · 2016: 11
- FWCI
- 4.50
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Heart Association (UL1 RR024156, UL1 TR000040, 9750432N)
- National Institutes of Health (UL1TR000040, TR000040)
- National Center for Research Resources (UL1RR024156)
- National Center for Advancing Translational Sciences (TR000040)
- Actelion Pharmaceuticals
- Topics
- Health Sciences › Medicine › Clinical Neurology › Intracranial Aneurysms: Treatment and Complications
- Health Sciences › Medicine › Clinical Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Keywords
- subarachnoid hemorrhage, loss of consciousness, early brain injury, functional outcome, mortality, cardiac arrest, intraventricular hemorrhage, delayed cerebral ischemia, aneurysm rebleeding, clinical grade, prognostic factors, modified Rankin Scale, long-term outcome prediction, spontaneous intracranial hemorrhage
- MeSH terms
- Adult, Aged, Brain Injuries, Female, Humans, Male, Middle Aged, Patient Discharge, Prospective Studies, Retrospective Studies, Risk Factors, Subarachnoid Hemorrhage, Unconsciousness, Early Diagnosis
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