Functional outcome after aneurysmal subarachnoid hemorrhage

Abstract

The introduction of the operating microscope, the principle of early surgery, specialized intensive care units, the calcium antagonist nimodipine, the sophisticated pre- and postoperative management and an aggressive antiischemic pharmacological management have substantially reduced morbidity and mortality after aneurysmal subarachnoid hemorrhage (SAH). In spite of this progress, many patients after rupture and surgical repair of an intracranial aneurysm exhibit substantial cognitive deficits and emotional problems although their neurological outcome was rated as good according to the Glasgow Outcome Scale (GOS = I). Therefore, a comprehensive neuropsychological examination is called for in order to evaluate the factual functional outcome after SAH. Neither focal brain damage associated with aneurysm location nor surgery but the hemorrhage itself and related events can be regarded as the most important causal factors for the late result after SAH. In contrast to the mild permanent effects of aneurysm surgery, the initial bleeding itself seems to have substantial lasting adverse neurobehavioral effects after. In concordance with other authors our own data stress the strong predictive power of the bleeding pattern such as the presence of intraventricular and/or intracerebral blood on the functional outcome after aneurysmal SAH.