Background and objectives: multiple sclerosis (MS) is a chronic demyelinating disorder of the CNS with a variable course and disability progression. The latter may be prevented with disease-modifying therapy (DMT). Initial misdiagnosis may postpone the use of DMT. There are no studies to explore whether initial misdiagnosis is indeed associated with a higher rate of reaching disability in MS patients. We aimed to investigate the association between initial misdiagnosis and reaching disability milestones in relapsing-remitting MS (RR-MS) patients. Materials and methods: Data from 128 RR-MS patients were retrospectively reviewed. EDSS 4 and EDSS 6 were chosen as disability milestones as those associated with a significant decrease in ambulation. Survival analysis was used, and Kaplan–Meier curves were generated to investigate how initial misdiagnosis affects reaching the defined milestones. Results: 53 patients (41.4%, 31 females, 22 males) were initially misdiagnosed. Initially misdiagnosed patients had a lesser risk of reaching EDSS 4 up to 11 years and EDSS 6 up to 22 years from the onset than non-misdiagnosed patients (p = 0.22 and p = 0.25 correspondingly). Median time to reaching EDSS 4 and 6 was eight years (95% CI 0.0–17.6) and 10 years (95% CI 4.25–20.75) in misdiagnosed and three years (95% CI 0.0–20.0 years) and five years (95% CI 0.0–13.73 years) in non-misdiagnosed patients correspondingly. Conclusions: Initially misdiagnosed RR-MS patients tended to reach disability milestones later than non-misdiagnosed ones, which might reflect an intrinsically milder disease. Individuals presenting with mild or non-specific symptoms suspicious of MS, must be deliberately managed.

Introduction. Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high mortality and disability. Previous studies have reported a range of factors influencing in-hospital mortality after aSAH, sometimes with conflicting findings. This study aimed to identify predictors of fatal outcomes in ruptured cerebral aneurysms (CAs). Methods. The study analyzed medical records of 421 patients with ruptured CAs. Data included demographics, clinical characteristics, comorbidities, CA size and location, intracranial and infectious complications, and conditions requiring tracheostomy. Results. Conservative treatment increased the mortality risk fourfold (p < 0.001). Men treated conservatively had a 2.4-fold higher mortality risk (p = 0.039). Each additional hospital day reduced the mortality risk by a factor of 1.09 in microsurgically treated patients (p < 0.001) and by a factor of 1.15 in those receiving conservative treatment (p < 0.001). Preoperative recurrent hemorrhage was associated with a 2.3 times higher mortality risk in microsurgically treated patients (p = 0.003) and a 7.6 times higher risk in patients receiving conservative treatment (p < 0.001). In microsurgically treated patients, aneurysms in the anterior cerebral artery territory increased the mortality risk 2.3-fold (p = 0.007), while in conservatively treated patients, aneurysms in the middle cerebral artery territory increased it 3.3-fold (p = 0.044). A history of arterial hypertension was associated with a 1.83-fold lower risk of mortality among microsurgically treated patients (p = 0.042). Seizures at admission increased mortality fivefold in conservatively treated patients (p = 0.021), while headache at admission reduced mortality 2.2-fold in microsurgically (p = 0.037) and 3.26-fold in conservatively treated patients (p = 0.024). A higher WFNS grade was also a significant predictor of in-hospital mortality. Vasospasm tripled the mortality risk in microsurgically treated patients (p < 0.001). Regardless of treatment, pneumonia and conditions requiring tracheostomy increased mortality (p < 0.001). Surgery reduced mortality in patients with SAH and intraventricular hemorrhage or SAH and parenchymal hemorrhage, lowering the risk 5.15-fold (p = 0.03) and 8.7-fold (p = 0.01), respectively. Conclusions. Key mortality predictors include male sex, hospital stay duration, extent of hemorrhage, preoperative recurrent hemorrhage, CA location, seizures, absence of headache, a higher WFNS grade, vasospasm, pneumonia, and conditions requiring tracheostomy.

Aneurysmal subarachnoid hemorrhage (aSAH) remains a life-threatening condition with high mortality and disability rates, despite advances in treatment. Accurate clinical outcome assessment is essential for patient care and research; yet, a standardized approach is currently lacking. A structured PubMed search was conducted using the keywords "aneurysmal subarachnoid hemorrhage," "assessment scale," and "outcome." Titles, abstracts, and full texts of eligible studies were screened. Extracted data were analyzed to summarize the use, strengths, and limitations of outcome assessment instruments applied in aSAH research. Simplistic dichotomization into "favorable" or "unfavorable" outcomes fails to reflect the full clinical spectrum. More detailed instruments such as the extended Glasgow Outcome Scale and structured modified Rankin Scale interviews exist but are often impractical in routine neurosurgical settings. Recent international efforts, including a 2025 Delphi survey, highlight the need to incorporate cognitive, emotional, and functional domains into outcome evaluation-areas still underrepresented. To address these gaps, we propose the Hospital Assessment Scale (HAS), a simplified four-point ordinal scale for in-hospital use. A score of 0 indicates no neurological deficit; 1 indicates a deficit not requiring caregiver support; 2 indicates a deficit requiring support; and 3 indicates death. The HAS provides a standardized, nondichotomized approach, supports discharge planning, and enhances consistency across clinical studies. Implementing the HAS may enhance the quality and comparability of outcome assessment in aSAH, thereby improving clinical decision-making and the design of future studies.