Aneurysmal subarachnoid haemorrhage: outcomes of early rehabilitation after surgical repair of ruptured intracranial aneurysms

Abstract

Objectives: The aim was to analyse functional and cognitive outcomes in patients receiving early rehabilitation treatment after surgery for aneurysmal subarachnoid haemorrhage (SAH). Methods: The assessment protocol included all relevant clinical data, the Hunt-Hess scale, the functional independence measure (FIM), and the mini mental state examination (MMSE). Results: Of 59 patients included in the study, 52.5% (31) were men and 47.5% (28) were women. The patients' average age was 52 years, and 57.6% were employed at the time of the aneurysm rupture. The mean duration of hospital stay was 25 days; 67.8% (40) of the patients were discharged home. At discharge, 72.7% of the patients were without any motor impairment, but 59.6% showed cognitive impairment. By the time of discharge, 43.4% (23) of the patients had attained independence in activites of daily living, 18.9% (10) needed intermittent supervision, and 37.7% (20) required constant supervision in the performance of these activities. Conclusions: The severity of cognitive impairment has predictive value for the functional status and the level of supervision required at discharge. S ubarachnoid haemorrhage (SAH) is a common and often devastating occurrence. This pathology accounts for 5%-10% of all strokes, affecting mostly people in the 5th decade of life, at the peak of their productivity.

Predictors for cognitive impairment one year after surgery for aneurysmal subarachnoid hemorrhage

“…Existing studies still lack consensus concerning which disease factors are the most influential for cognitive dysfunction after SAH and makes predictions in the present study open. Heterogeneous results are probably due to the large number of possible pre-, peri-, and post-operative factors that may influence the brain and recovery of cognitive functioning [3,10,13,23,26,30,36,37,39,[42][43][44]. Differences in methodology between cognitive studies may also produce heterogeneous results such as differences in test batteries applied for assessment of cognitive functions, small sample sizes and intra-sample heterogeneity [1,26,27,39].…”

“…It has become well recognized that patients surgically treated for SAH often struggle with persisting cognitive impairments despite being neurologically intact [4,7,9,10,13,17,23,30,36,37,39,43]. Knowledge of the disease factors that influence long-term cognitive outcome after SAH is clinically important as such factors are possibly modifi-■ Abstract Objective To assess predictors for cognitive impairment one year after spontaneous subarachnoid hemorrhage (SAH).…”

Working with a brain injury: Personal experiences of returning to work following a mild or moderate brain injury

“…In addition, work-disabled individuals with other longterm conditions, for example rheumatoid arthritis and multiple sclerosis, have been shown to suffer increased depression and reduced QoL (13,14). However, individuals who return to work after stroke report significantly higher subjective well-being and life satisfaction and fewer unmet needs (20,21). Although for some brain injury survivors return to work may be unrealistic, it is reasonable to assume that the majority of those in work at the time of their injury will want to go back to work.…”

Clinical assessment of deficits after SAH: hasty neurosurgeons and accurate neurologists

“…This might impact referral patterns to rehabilitation, especially in patients with good outcome using the mRS and GOS. The detection of cognitive deficits and referral to specialized therapy has the potential to provide benefit to a large group of patients [9]. This indicates the need for a neuropsychological assessment to identify cognitive deficits in acute care for a better triage of patients to rehabilitation or for discharge home [7].…”