Cognitive and Functional Outcome After Aneurysmal Subarachnoid Hemorrhage

Abstract

Background and Purpose-Aneurysmal subarachnoid hemorrhage (aSAH) is a medical emergency characterized by the accumulation of blood in the subarachnoid space surrounding the brain. The acute treatment of aSAH is well documented but less is known about the long-term effects of aSAH on cognition and day-to-day functioning. Methods-We reviewed all studies in the past 10 years that have focused on the effects of aSAH on cognition and day-to-day functioning. Results-Sixty-one empirical studies examining cognitive and functional outcome in patients with aSAH met inclusion criteria. Survivors of aSAH commonly experience deficits in memory, executive function, and language. These cognitive impairments interact to affect patients' day-to-day functioning, including activities of daily living, instrumental activities of daily living, return to work, and quality of life. Deficits in cognition and day-to-day functioning are further compounded by depression, anxiety, fatigue, and sleep disturbances. Conclusions-Much remains to be learned about the brain changes underlying cognitive and functional deficits, including the role of diffuse brain damage and secondary complications like vasospasm and elevated intracranial pressure. A consideration of these issues is necessary to obtain a better understanding of how aSAH affects cognition and day-to-day functioning in the long-term. (Stroke. 2010;41:e519-e536.)

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

“…Apart from having a higher risk of death, those who survive are frequently left with various degrees of functional and cognitive limitations. [2][3][4][5][6][7][8] Only a small number of specific interventions have been definitively demonstrated in large randomized controlled trials to improve outcomes in neurocritical care. [9][10][11][12][13][14] Many of the treatments that are recommended in consensus guidelines and incorporated into protocols are, by necessity, based on low-quality evidence derived largely from observational studies.…”

Longitudinal profile of iron accumulation in good‐grade subarachnoid hemorrhage

“…Despite advances in emergency and neurocritical care management, aneurysmal subarachnoid hemorrhage (SAH) is still a devastating disease with up to 95% of survivors reporting cognitive impairment and poor quality of life 1. Factors associated with unfavorable cognitive outcome include initial disease severity, the amount of subarachnoid blood, aneurysm location, and the occurrence of secondary complications such as delayed cerebral ischemia, and elevated intracranial pressure 2, 3.…”

Astrocyte Ca2+Signaling Drives Inversion of Neurovascular Coupling after Subarachnoid Hemorrhage

“…Interestingly, although the NVC response switched from vasodilation to vasoconstriction, neurally evoked changes in endfoot Ca 2ϩ were not altered by SAH. Strokes caused by cerebral aneurysm rupture and SAH are associated with a high incidence of morbidity and mortality that often manifest several days after the initial bleed (Al-Khindi et al, 2010;Østergaard et al, 2013). The inversion of NVC may be an important contributor to delayed cerebral ischemia, development of neurological deficits, and poor outcome frequently observed in SAH patients .…”