Focal Neurological Deficits and Early Brain Injury Outcomes in Subarachnoid Hemorrhage Patients

Objective To identify the subarachnoid hemorrhage (SAH) patients with focal neurological deficits (FND) at onset and compare their Subarachnoid hemorrhage Early Brain Edema Score(SEBES) and outcomes with non‐FND SAH patients. Background Early brain injury (EBI) in SAH is a growing concept that refers to secondary brain damage within the first 72 hours and SEBES is a validated radiographic marker of EBI. SAH presents infrequently with FND. FND as a clinical marker of EBI has not been previously explored. Design/Methodology Institutional stroke database was reviewed for spontaneous SAH between 2020‐2024. SEBES score was calculated for each case by arrival CT analysis. SAH with FND cohort was compared with SAH without FND using t‐test (continuous) or chi‐squared test (categorical). Clinical and neuroimaging predictors of an unfavorable discharge outcome (modified Rankin score ≥3) were assessed in univariable and multivariable logistic regression models. Finally, an association testing for FND with SEBES was done. Results Analysis included 88 SAH and 21 of them FND. Most common FND was right hemiparesis (47.6%). FND group had more males (85.7vs.58.2%), higher mFS, SEBES and discharge mRS; more DCI and required more open surgical intervention. FND, High SEBES (3‐4), mFS, radiographic vasospasm, and DCI were strong predictors of poor outcome (p<0.05) in univariable analysis. High SEBES remained statistically significant in multivariable model (OR 4.418, (1.449‐14.518)). FND was 85.5% specific for high SEBES. Conclusions Presence of FND in SAH was independently associated with poor outcomes in a univariate model and had nonsignificant but promising trend in multivariable analysis. High SEBES score was highly associated with poor outcome in both uni‐ and multi‐variable models. Association between FND and EBI needs to be explored in larger datasets.