Long-term outcomes after non-aneurysmal, non-traumatic subarachnoid hemorrhage: a prospective multicenter outcome study

OBJECTIVE: Non-aneurysmal, non-traumatic subarachnoid hemorrhage (nSAH) refers to cases where a causative aneurysm cannot be identified. Stratification into perimesencephalic non-aneurysmal SAH (PMSAH) and non-perimesencephalic non-aneurysmal subarachnoid hemorrhage (NPSAH) is important for clinical purposes. The nSAH patients, in particular PMSAH patients, tend to have a better prognosis, as compared with aneurysmal subarachnoid hemorrhage patients. We prospectively studied functional outcome, return to work (RTW) status, quality of life and residual symptoms at least one year after the hemorrhage in these patients. METHODS: This multicenter study, conducted in Amsterdam UMC (Netherlands) and University Hospital Zurich (Switzerland), included adult nSAH patients admitted between 2015 and 2021. Outcomes, including the modified Rankin Scale (mRS), RTW status, the EuroQol-5Dimensions, EuroQol-Visual Analogue Scale, the Checklist Cognition and Emotion 24 items, and the Stroke-Specific Quality of Life Scale were prospectively assessed. RESULTS: Of 262 potential participants, 111 patients (66 NPSAH and 45 PMSAH; response rate 42%) returned the questionnaire, whereas 109 (41%) patients completed the telephone interview. The median follow-up time was 58.2 months (range 28.9-72.3). An mRS-score of ≥2 was recorded in 44 (40%) patients. Among 85 of 87 (RTW status missing in two patients) previously employed patients at the time of the hemorrhage, 61 (70%) fully RTW, 11 (13%) partially RTW, and 13 (15%) did not return to work. Twenty-eight (26%) patients had no complaints at all at follow-up. Frequently reported residual symptoms involved increased tiredness and difficulties remembering new information. CONCLUSIONS: Long-term follow-up of nSAH patients reveals that 40% reports an mRS-score of ≥2. Furthermore, 28% of previously employed patients did not (fully) return to work and the majority of patients reports residual symptoms at follow-up. Our findings show that a larger part of non-aneurysmal, non-traumatic SAH patients can not resume all previous activities than previously reported, even at long-term follow-up.