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Harmsen WJ, Ribbers GM, Heijenbrok-Kal MH, Khajeh L, Sneekes EM, van Kooten F, Neggers SJCMM, van den Berg-Emons RJ. Fatigue After Aneurysmal Subarachnoid Hemorrhage Is Highly Prevalent in the First-Year Postonset and Related to Low Physical Fitness: A Longitudinal Study. Am J Phys Med Rehabil 2019; 98:7-13. [PMID: 29863585 DOI: 10.1097/phm.0000000000000976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate whether low physical fitness and inactive and sedentary lifestyles play a role in the severity of fatigue in patients with aneurysmal subarachnoid hemorrhage (a-SAH). DESIGN This is a prospective 1-yr follow-up study, including a total of 52 patients with a-SAH. Outcome measures included the Fatigue Severity Scale score, peak oxygen uptake (VO2peak), isokinetic knee muscle strength (peak torque), physical activity (% 24-hr period), and sedentary behavior (% waking hours) and were evaluated at 6 and 12 mos after onset. RESULTS Fatigue was highly prevalent in the first year and reported by 48% of the patients at 6 mos and by 52% at 12 mos after a-SAH. Fatigue was associated with the knee extension (P < 0.001) and flexion strength (P < 0.001). A nonsignificant trend for a relationship was found between fatigue and the aerobic capacity (P = 0.079). No relationships were found between fatigue and physical activity or sedentary behavior. Fatigue could not be predicted by disease-related characteristics. CONCLUSIONS Half of the patients were fatigued in the first year after a-SAH. Interventions are necessary to reduce fatigue and should consider exercise training as a potential contributor to a multimodal treatment, preventing debilitating conditions after a-SAH. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Recognize the association between fatigue and physical fitness in patients after aneurysmal subarachnoid hemorrhage; (2) Determine the severity of fatigue complaints in patient after aneurysmal subarachnoid hemorrhage; and (3) Discuss the role of physical deconditioning in the management of fatigue in patients after aneurysmal subarachnoid hemorrhage. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Wouter J Harmsen
- From the Rijndam Rehabilitation Institute, Rotterdam, the Netherlands (WJH, GMR, MHH-K, EMS, RJvdB-E); and Departments of Rehabilitation Medicine (WJH, GMR, MHH-K, EMS, RJvdB-E), Neurology (LK, FvK), and Endocrinology (SJCMMN), Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Harmsen WJ, Khajeh L, Ribbers GM, Heijenbrok-Kal MH, Sneekes E, van Kooten F, Neggers S, van den Berg-Emons RJ. People With Aneurysmal Subarachnoid Hemorrhage Have Low Physical Fitness and Can Be Predisposed to Inactive and Sedentary Lifestyles. Phys Ther 2019; 99:904-914. [PMID: 31220327 PMCID: PMC7207355 DOI: 10.1093/ptj/pzz046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/28/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Physical inactivity, sedentary lifestyles, and low functional outcome are thought to impact the level of physical fitness in patients with aneurysmal subarachnoid hemorrhage (a-SAH). However, changes in fitness over time and associated factors have not been studied in a-SAH. OBJECTIVE The objective was to evaluate the level of physical fitness in the first year after a-SAH and explore longitudinal relations with physical activity, sedentary behavior, and functional outcome. Additionally, we evaluated whether physical fitness could be predicted by disease-related characteristics (ie, severity of a-SAH, location of the aneurysm, treatment procedure, pituitary dysfunction, and complications). DESIGN This was a prospective 1-year follow-up study. METHODS Fifty-two participants performed exercise testing at 6 and 12 months after a-SAH. Cardiopulmonary exercise testing and isokinetic dynamometry were applied to determine the peak oxygen uptake $({\rm{\dot{V}}}{{\rm{o}}_{2{\rm{peak}}}})$ and the peak torque of the knee extensors (PText) and flexors (PTflex). In addition, physical activity and sedentary behavior were evaluated by accelerometer-based activity monitoring. The functional outcome was assessed by the Functional Independence Measure and Functional Assessment Measure. Disease-related characteristics were collected at hospital intake. RESULTS At both 6 and 12 months, all fitness parameters were lower compared with predicted values (ranging from 18% to 28%). Physical activity is related to both ${\rm{\dot{V}}}{{\rm{o}}_{{\rm{2peak}}}}$ and PTflex. The Functional Independence Measure and Functional Assessment Measure scores was related to PText and PTflex. Further, participants who underwent surgical clipping had lower ${\rm{\dot{V}}}{{\rm{o}}_{{\rm{2peak}}}}$ and PTflex. LIMITATIONS Longitudinal observations cannot confirm causality. CONCLUSIONS Levels of physical fitness remain low over the first year after a-SAH. Participants who were physically more active had higher levels of physical fitness, whereas participants with impaired functional outcome or who were treated with surgical clipping were at risk of low physical fitness. Exercise interventions are warranted and should focus on the promotion of physical activity and target patients with impaired functional outcome or those who have been treated with surgical clipping.
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Affiliation(s)
- Wouter J Harmsen
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands; and Department of Rehabilitation Medicine, Erasmus MC University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands,Address all correspondence to Dr Harmsen at:
| | - Ladbon Khajeh
- Department of Neurology, Erasmus MC University Medical Center
| | - Gerard M Ribbers
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
| | - Majanka H Heijenbrok-Kal
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
| | - Emiel Sneekes
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
| | - Fop van Kooten
- Department of Neurology, Erasmus MC University Medical Center
| | | | - Rita J van den Berg-Emons
- Rijndam Rehabilitation Institute, and Department of Rehabilitation Medicine, Erasmus MC University Medical Center
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Harmsen WJ, Ribbers GM, Heijenbrok-Kal MH, Bussmann JBJ, Sneekes EM, Khajeh L, van Kooten F, Neggers SJCMM, van den Berg-Emons RJ. Inactive lifestyles and sedentary behavior in persons with chronic aneurysmal subarachnoid hemorrhage: evidence from accelerometer-based activity monitoring. J Neuroeng Rehabil 2017; 14:120. [PMID: 29169368 PMCID: PMC5701368 DOI: 10.1186/s12984-017-0331-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 10/31/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (a-SAH) is a potential life-threatening stroke. Because survivors may be at increased risk for inactive and sedentary lifestyles, this study evaluates physical activity (PA) and sedentary behavior (SB) in the chronic phase after a-SAH. METHODS PA and SB were objectively measured at six months post a-SAH with an accelerometer-based activity monitor, with the aim to cover three consecutive weekdays. Total time spent in PA (comprising walking, cycling, running and non-cyclic movement) and SB (comprising sitting and lying) was determined. Also, in-depth analyses were performed to determine the accumulation and distribution of PA and SB throughout the day. Binary time series were created to determine the mean bout length and the fragmentation index. Measures of PA and SB in persons with a-SAH were compared to those in sex- and age-matched healthy controls. RESULTS The 51 participants comprised 33 persons with a-SAH and 18 controls. None of the participants had signs of paresis or spasticity. Persons with a-SAH spent 105 min/24 h being physically active, which was 35 min/24 h less than healthy controls (p = 0.005). For PA, compared with healthy controls, the mean bout length was shorter in those with a-SAH (12.0 vs. 13.5 s, p = 0.006) and the fragmentation index was higher (0.053 vs. 0.041, p < 0.001). Total sedentary time during waking hours showed no significant difference between groups (514 min vs. 474 min, p = 0.291). For SB, the mean bout length was longer in persons with a-SAH (122.3 vs. 80.5 s, p = 0.024), whereas there was no difference in fragmentation index between groups (0.0032 vs 0.0036, p = 0.396). CONCLUSIONS Persons with a-SAH are less physically active, they break PA time into shorter periods, and SB periods last longer compared to healthy controls. Since inactive lifestyles and prolonged uninterrupted periods of SB are independent risk factors for poor cardiovascular health, interventions seem necessary and should target both PA and SB. STUDY REGISTRATION Dutch registry number: NTR 2085.
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Affiliation(s)
- Wouter J Harmsen
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands. .,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Gerard M Ribbers
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johannes B J Bussmann
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Emiel M Sneekes
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Ladbon Khajeh
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sebastian J C M M Neggers
- Department of Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rita J van den Berg-Emons
- Rijndam Rehabilitation Institute, Rotterdam, the Netherlands.,Department of Rehabilitation Medicine, Erasmus MC University Medical Center Rotterdam, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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Harmsen WJ, Ribbers GM, Slaman J, Heijenbrok-Kal MH, Khajeh L, van Kooten F, Neggers SJCMM, van den Berg-Emons RJ. The six-minute walk test predicts cardiorespiratory fitness in individuals with aneurysmal subarachnoid hemorrhage. Top Stroke Rehabil 2016; 24:250-255. [PMID: 27915583 DOI: 10.1080/10749357.2016.1260263] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Peak oxygen uptake (VO2peak) established during progressive cardiopulmonary exercise testing (CPET) is the "gold-standard" for cardiorespiratory fitness. However, CPET measurements may be limited in patients with aneurysmal subarachnoid hemorrhage (a-SAH) by disease-related complaints, such as cardiovascular health-risks or anxiety. Furthermore, CPET with gas-exchange analyses require specialized knowledge and infrastructure with limited availability in most rehabilitation facilities. OBJECTIVES To determine whether an easy-to-administer six-minute walk test (6MWT) is a valid clinical alternative to progressive CPET in order to predict VO2peak in individuals with a-SAH. METHODS Twenty-seven patients performed the 6MWT and CPET with gas-exchange analyses on a cycle ergometer. Univariate and multivariate regression models were made to investigate the predictability of VO2peak from the six-minute walk distance (6MWD). RESULTS Univariate regression showed that the 6MWD was strongly related to VO2peak (r = 0.75, p < 0.001), with an explained variance of 56% and a prediction error of 4.12 ml/kg/min, representing 18% of mean VO2peak. Adding age and sex to an extended multivariate regression model improved this relationship (r = 0.82, p < 0.001), with an explained variance of 67% and a prediction error of 3.67 ml/kg/min corresponding to 16% of mean VO2peak. CONCLUSIONS The 6MWT is an easy-to-administer submaximal exercise test that can be selected to estimate cardiorespiratory fitness at an aggregated level, in groups of patients with a-SAH, which may help to evaluate interventions in a clinical or research setting. However, the relatively large prediction error does not allow for an accurate prediction in individual patients.
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Affiliation(s)
- Wouter J Harmsen
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Gerard M Ribbers
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Jorrit Slaman
- b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Majanka H Heijenbrok-Kal
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
| | - Ladbon Khajeh
- c Department of Neurology , Erasmus University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Fop van Kooten
- c Department of Neurology , Erasmus University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Sebastiaan J C M M Neggers
- d Department of Endocrinology , Erasmus University Medical Center Rotterdam , Rotterdam , The Netherlands
| | - Rita J van den Berg-Emons
- a Rijndam Rehabilitation Institute , Rotterdam , The Netherlands.,b Department of Rehabilitation Medicine , Erasmus University Medical Center Rotterdam , Rotterdam , the Netherlands
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Boerboom W, van Zandvoort MJE, van Kooten F, Khajeh L, Visser-Meily JMA, Ribbers GM, Heijenbrok-Kal MH. Long-term fatigue after perimesencephalic subarachnoid haemorrhage in relation to cognitive functioning, mood and comorbidity. Disabil Rehabil 2016; 39:928-933. [DOI: 10.3109/09638288.2016.1172671] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Wendy Boerboom
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martine J. E. van Zandvoort
- Department of Neurology, Brain Center Rudolf Magnus Institute, & Experimental Psychology, Helmholtz Institute, University Medical Center Utrecht, The Netherlands
| | - Fop van Kooten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ladbon Khajeh
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johanna M. A. Visser-Meily
- Brain Center Rudolf Magnus Institute, Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Gerard M. Ribbers
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Majanka H. Heijenbrok-Kal
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Khajeh L, Ribbers GM, Heijenbrok-Kal MH, Blijdorp K, Dippel DWJ, Sneekes EM, van den Berg-Emons HJG, van der Lely AJ, Neggers SJCMM, van Kooten F. The effect of hypopituitarism on fatigue after subarachnoid hemorrhage. Eur J Neurol 2016; 23:1269-74. [PMID: 27128968 DOI: 10.1111/ene.13014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/02/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysmal subarachnoid hemorrhage (SAH) survivors often complain of fatigue, which is disabling. Fatigue is also a common symptom of pituitary dysfunction (PD), in particular in patients with growth hormone deficiency (GHD). A possible association between fatigue after SAH and long-term pituitary deficiency in SAH survivors has not yet been established. METHODS A single center observational study was conducted amongst 84 aneurysmal SAH survivors to study the relationship between PD and fatigue over time after SAH, using mixed model analysis. Fatigue was measured with the Fatigue Severity Scale and its relationships with other clinical variables were studied. RESULTS Three-quarters of respondents (76%) have pathological fatigue directly after SAH and almost two-thirds (60%) of patients still have pathological levels of fatigue after 14 months. The severity of SAH measured with a World Federation of Neurosurgical Societies (WFNS) score higher than 1 (P = 0.008) was associated with long-term fatigue. There is no statistically significant effect of PD (P = 0.8) or GHD (P = 0.23) on fatigue in SAH survivors over time. CONCLUSIONS Fatigue is a common symptom amongst SAH survivors. WFNS is a usable clinical determinant of fatigue in SAH survivors. Neither PD nor GHD has a significant effect on long-term fatigue after SAH.
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Affiliation(s)
- L Khajeh
- Department of Neurology, Section Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G M Ribbers
- Department of Rehabilitation, Erasmus University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - M H Heijenbrok-Kal
- Department of Rehabilitation, Erasmus University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - K Blijdorp
- Department of Medicine, Section Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D W J Dippel
- Department of Neurology, Section Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E M Sneekes
- Department of Rehabilitation, Erasmus University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - H J G van den Berg-Emons
- Department of Rehabilitation, Erasmus University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - A J van der Lely
- Department of Medicine, Section Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S J C M M Neggers
- Department of Medicine, Section Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F van Kooten
- Department of Neurology, Section Endocrinology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
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Harmsen W, Ribbers G, Zegers B, Sneekes E, Heijenbrok-Kal M, Khajeh L, Kooten F, Neggers S, Berg-Emons R. Impaired cardiorespiratory fitness after aneurysmal subarachnoid hemorrhage. J Rehabil Med 2016; 48:769-775. [DOI: 10.2340/16501977-2127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Boerboom W, Heijenbrok-Kal M, Kooten F, Khajeh L, Ribbers G. Unmet needs, community integration and employment status four years after subarachnoid haemorrhage. J Rehabil Med 2016; 48:529-34. [DOI: 10.2340/16501977-2096] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Khajeh L, Blijdorp K, Heijenbrok-Kal MH, Sneekes EM, van den Berg-Emons HJG, van der Lely AJ, Dippel DWJ, Neggers SJCMM, Ribbers GM, van Kooten F. Pituitary dysfunction after aneurysmal subarachnoid haemorrhage: course and clinical predictors—the HIPS study. J Neurol Neurosurg Psychiatry 2015; 86:905-10. [PMID: 25378238 PMCID: PMC4516005 DOI: 10.1136/jnnp-2014-307897] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/28/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We describe the occurrence and course of anterior pituitary dysfunction (PD) after aneurysmal subarachnoid haemorrhage (SAH), and identify clinical determinants for PD in patients with recent SAH. METHODS We prospectively collected demographic and clinical parameters of consecutive survivors of SAH and measured fasting state endocrine function at baseline, 6 and 14 months. We included dynamic tests for growth-hormone function. We used logistic regression analysis to compare demographic and clinical characteristics of patients with SAH with and without PD. RESULTS 84 patients with a mean age of 55.8 (±11.9) were included. Thirty-three patients (39%) had PD in one or more axes at baseline, 22 (26%) after 6 months and 6 (7%) after 14 months. Gonadotropin deficiency in 29 (34%) patients and growth hormone deficiency (GHD) in 26 (31%) patients were the most common deficiencies. PD persisted until 14 months in 6 (8%) patients: GHD in 5 (6%) patients and gonadotropin deficiency in 4 (5%). Occurrence of a SAH-related complication was associated with PD at baseline (OR 2.6, CI 2.2 to 3.0). Hydrocephalus was an independent predictor of PD 6 months after SAH (OR 3.3 CI 2.7 to 3.8). PD was associated with a lower score on health-related quality of life at baseline (p=0.06), but not at 6 and 14 months. CONCLUSIONS Almost 40% of SAH survivors have PD. In a small but substantial proportion of patients GHD or gonadotropin deficiency persists over time. Hydrocephalus is independently associated with PD 6 months after SAH. TRIAL REGISTRATION NUMBER NTR 2085.
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Affiliation(s)
- L Khajeh
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - K Blijdorp
- Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M H Heijenbrok-Kal
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - E M Sneekes
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - H J G van den Berg-Emons
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - A J van der Lely
- Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D W J Dippel
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S J C M M Neggers
- Department of Medicine, Section Endocrinology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - G M Ribbers
- Department of Rehabilitation, Erasmus MC University Medical Center and Rijndam Rehabilitation Center Rotterdam, Rotterdam, The Netherlands
| | - F van Kooten
- Department of Neurology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Khajeh L, Blijdorp K, Neggers SJ, Ribbers GM, Dippel DW, van Kooten F. Hypopituitarism after subarachnoid haemorrhage, do we know enough? BMC Neurol 2014; 14:205. [PMID: 25312299 PMCID: PMC4207357 DOI: 10.1186/s12883-014-0205-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 10/02/2014] [Indexed: 12/20/2022] Open
Abstract
Background Fatigue, slowness, apathy and decrease in level of activity are common long-term complaints after a subarachnoid haemorrhage (SAH). They resemble the symptoms frequently found in patients with endocrine dysfunction. Pituitary dysfunction may be the result of SAH or its complications. We therefore hypothesized that it may explain some of the long-term complaints after SAH. We reviewed the literature to clarify the occurrence, pattern and severity of endocrine abnormalities and we attempted to identify risk factors for hypopituitarism after SAH. We also assessed the effect of hypopituitarism on long-term functional recovery after SAH. Methods In a MEDLINE search for studies published between 1995 and 2014, we used the term subarachnoid haemorrhage in combination with pituitary, hypopituitarism, growth hormone, gonadotropin, testosterone, cortisol function, thyroid function and diabetes insipidus. We selected all case-series and cohort studies reporting endocrine function at least 3 months after SAH and studied their reported prevalence, pathogenesis, risk factors, clinical course and outcome. Results We identified 16 studies describing pituitary function in the long term after SAH. The reported prevalence of endocrine dysfunction varied from 0 to 55% and the affected pituitary axes differed between studies. Due to methodological issues no inferences on risk factors, course and outcome could be made. Conclusions Neuroendocrine dysfunction may be an important and modifiable determinant of poor functional outcome after SAH. There is an urgent need for well-designed prospective studies to more precisely assess its incidence, clinical course and effect on mood, behaviour and quality of life. Electronic supplementary material The online version of this article (doi:10.1186/s12883-014-0205-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ladbon Khajeh
- Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Karin Blijdorp
- Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
| | - Sebastian Jcmm Neggers
- Department of Internal Medicine, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
| | - Gerard M Ribbers
- Department of Rehabilitation Medicine, Erasmus MC University Medical Centre and Rijndam Rehabilitation Centre, Rotterdam, the Netherlands.
| | - Diederik Wj Dippel
- Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Fop van Kooten
- Department of Neurology, Erasmus MC University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Boerboom W, Heijenbrok-Kal MH, Khajeh L, van Kooten F, Ribbers GM. Long-term Functioning of Patients With Aneurysmal Subarachnoid Hemorrhage: a 4-year Follow-up Study. Arch Phys Med Rehabil 2014. [DOI: 10.1016/j.apmr.2014.07.387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khajeh L, Cherian PJ, Swarte RM, Smit LS, Lequin MH. The puzzle of apparent life-threatening events in a healthy newborn. J Child Neurol 2014; 29:969-72. [PMID: 23529910 DOI: 10.1177/0883073813481403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/13/2013] [Indexed: 11/16/2022]
Abstract
Apneic neonatal seizures can present as apparent life-threatening events. We report a newborn with unexplained episodes of apnea associated with cyanosis and desaturation, starting on the first day postpartum. Biochemical tests were normal. Central nervous system infections as well as abnormalities of upper airways and cardiovascular system were excluded. Brain monitoring using amplitude-integrated electroencephalography (aEEG) was inconclusive. Continuous monitoring using video EEG revealed epileptic seizures originating from the left temporal region as the cause of the apneas. Magnetic resonance imaging (MRI) of the brain showed a developmental malformation of the left frontal and temporal lobes. The patient became seizure free after treatment with antiepileptic medication. This report illustrates that brain monitoring using amplitude-integrated EEG alone could miss focal neonatal seizures. When clinical suspicion of apneic seizures is high in infants with apparent life threatening events, multichannel polygraphic video-EEG monitoring is indicated. Prompt diagnosis and treatment can be life saving.
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Affiliation(s)
- Ladbon Khajeh
- Section of Clinical Neurophysiology, Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Perumpillichira J Cherian
- Section of Clinical Neurophysiology, Department of Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - Renate M Swarte
- Section of Neonatology, Department of Pediatrics, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Liesbeth S Smit
- Section of Pediatric Neurology, Department of Neurology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | - Maarten H Lequin
- Department of Pediatric Radiology, Erasmus MC-Sophia, Rotterdam, The Netherlands
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Boerboom W, Heijenbrok-Kal M, Khajeh L, Kooten F, Ribbers G. Differences in cognitive and emotional outcomes between patients with perimesencephalic and aneurysmal subarachnoid haemorrhage. J Rehabil Med 2014; 46:28-32. [DOI: 10.2340/16501977-1236] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Boerboom W, Jacobs E, Khajeh L, Kooten F, Ribbers G, Heijenbrok-Kal M. The relationship of coping style with depression, burden, and life dissatisfaction in caregivers of patients with subarachnoid haemorrhage. J Rehabil Med 2014; 46:321-6. [DOI: 10.2340/16501977-1273] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Blijdorp K, Khajeh L, Ribbers GM, Sneekes EM, Heijenbrok-Kal MH, van den Berg-Emons HJG, van der Lely AJ, van Kooten F, Neggers SJCMM. Diagnostic value of a ghrelin test for the diagnosis of GH deficiency after subarachnoid hemorrhage. Eur J Endocrinol 2013; 169:497-502. [PMID: 24037787 PMCID: PMC3776685 DOI: 10.1530/eje-13-0436] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine the diagnostic value of a ghrelin test in the diagnosis of GH deficiency (GHD) shortly after aneurysmal subarachnoid hemorrhage (SAH). DESIGN Prospective single-center observational cohort study. METHODS A ghrelin test was assessed after the acute phase of SAH and a GH-releasing hormone (GHRH)-arginine test 6 months post SAH. Primary outcome was the diagnostic value of a ghrelin test compared with the GHRH-arginine test in the diagnosis of GHD. The secondary outcome was to assess the safety of the ghrelin test, including patients' comfort, adverse events, and idiosyncratic reactions. RESULTS Forty-three survivors of SAH were included (15 males, 35%, mean age 56. 6 ± 11.7). Six out of 43 (14%) SAH survivors were diagnosed with GHD by GHRH-arginine test. In GHD subjects, median GH peak during ghrelin test was significantly lower than that of non-GHD subjects (5.4 vs 16.6, P=0.002). Receiver operating characteristics analysis showed an area under the curve of 0.869. A cutoff limit of a GH peak of 15 μg/l corresponded with a sensitivity of 100% and a false-positive rate of 40%. No adverse events or idiosyncratic reactions were observed in subjects undergoing a ghrelin test, except for one subject who reported flushing shortly after ghrelin infusion. CONCLUSION Owing to its convenience, validity, and safety, the ghrelin test might be a valuable GH provocative test, especially in the early phase of SAH.
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Affiliation(s)
- K Blijdorp
- Department of Medicine – EndocrinologyErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
| | - L Khajeh
- Department of NeurologyErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
- (Correspondence should be addressed to L Khajeh; )
| | - G M Ribbers
- Department of Rehabilitation MedicineErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
- Rijndam Rehabilitation CenterRotterdamThe Netherlands
| | - E M Sneekes
- Department of Rehabilitation MedicineErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
| | - M H Heijenbrok-Kal
- Department of Rehabilitation MedicineErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
- Rijndam Rehabilitation CenterRotterdamThe Netherlands
| | - H J G van den Berg-Emons
- Department of Rehabilitation MedicineErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
| | - A J van der Lely
- Department of Medicine – EndocrinologyErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
| | - F van Kooten
- Department of NeurologyErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
| | - S J C M M Neggers
- Department of Medicine – EndocrinologyErasmus University Medical Center RotterdamPO Box 20403000 CA, RotterdamThe Netherlands
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