The post-aSAH syndrome: a self-reported cluster of symptoms in patients with aneurysmal subarachnoid hemorrhage

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Although many patients recover to a good functional outcome after aneurysmal subarachnoid hemorrhage (aSAH), residual symptoms are very common and may have a large impact on the patient’s daily life. The particular cluster of residual symptoms after aSAH has not previously been described in detail and there is no validated questionnaire that covers the typical problems reported after aSAH. Many of the symptoms are similar to post-concussion syndrome, which often is evaluated with the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). In the present study, the authors therefore performed an exploratory use of the RPQ as a template to describe post-aSAH syndrome.


The RPQ was administered to 128 patients in the chronic phase after aSAH along with a battery of quality-of-life questionnaires. The patients also underwent a medical examination besides cognitive and physical testing. Based on their RPQ scores, patients were dichotomized into a “syndrome” group or “recovery” group.


A post-aSAH syndrome was seen in 33% of the patients and their symptom burden on all RPQ subscales was significantly higher than that of patients who had recovered on all RPQ subscales. The symptom cluster consisted mainly of fatigue, cognitive problems, and emotional problems. Physical problems were less frequently reported. Patients with post-aSAH syndrome scored significantly worse on mobility and pain scores, as well as on quality-of-life questionnaires. They also had significantly poorer scores on neuropsychological tests of verbal learning, verbal short- and long-term memory, psychomotor speed, and executive functions. Whereas 36% of the patients in the recovery group were able to return to their premorbid occupational status, this was true for only 1 patient in the syndrome group.


Approximately one-third of aSAH patients develop a post-aSAH syndrome. These patients struggle with fatigue and cognitive and emotional problems. Patients with post-aSAH syndrome report more pain and reduced quality of life compared to patients without this cluster of residual symptoms and have larger cognitive deficits. In this sample, patients with post-aSAH syndrome were almost invariably excluded from return to work. The RPQ is a simple questionnaire covering the specter of residual symptoms after aSAH. Being able to acknowledge these patients’ complaints as a defined syndrome using the RPQ should help patients to accept and cope, thereby alleviating possible secondary distress produced.

ABBREVIATIONS aSAH = aneurysmal subarachnoid hemorrhage; BRIEF-A = Behavior Rating Inventory of Executive Function–Adult version; HiMAT = High-Level Mobility Assessment Tool; HSCL-25 = Hopkins Symptom Checklist, 25-item version; PCS = post-concussion syndrome; PHQ = Patient Health Questionnaire; PTSD = posttraumatic stress disorder; RPQ = Rivermead Post-Concussion Symptoms Questionnaire; TBI = traumatic brain injury; VAS = visual analog scale.

Article Information

Correspondence Tonje Haug Nordenmark: Oslo University Hospital, Oslo, Norway.

INCLUDE WHEN CITING Published online April 19, 2019; DOI: 10.3171/2019.1.JNS183168.

Disclosures All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; or expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

© AANS, except where prohibited by US copyright law.



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    Percentage of patients reporting a moderate or severe problem for each RPQ question in the syndrome and recovery groups.

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    Work status of the patients in the syndrome and recovery groups at time of ictus and at 1 year past ictus (given in percentages).





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