Abstract
In about 25% of patients with spontaneous subarachnoid hemorrhage (SAH), a bleeding source cannot be identified during radiological diagnostics. Generally, the outcome of perimesencephalic or prepontine (PM) SAH is known to be significantly better than after non-PM SAH. Data about long-term follow-up concerning physical and mental health are scarce, so this study is reports on long-term results. We measured the influence of PM SAH on a quality-of-life modified Rankin (mRs) scale after six months. For long-term follow-up, a SF-36 questionnaire was used. Questionnaires were sent out between 18 and 168 months after ictus. In 37 patients, a long-term follow-up was available (up to 14 years after SAH). Data detected with the SF-36 questionnaire are compared to reference applicability to the standard population. In total, 37 patients were included for further analysis and divided in 2 subgroups; 13 patients (35%) received subsequent rehabilitation after clinical stay and 24 (65%) did not. In the short-term outcome, a significant improvement from discharge until follow-up was identified in patients with subsequent rehabilitation, but not in the matched pair group without rehabilitation. When PM SAH was compared to the standard population, a reduction in quality of life was identified in physical items (role limitations because of physical health problems, physical functioning) as well as in psychological items (role limitations because of emotional problems). Subsequent rehabilitation on PM SAH patients probably leads to an increase in independence and better mRs. While better mRs was shown at discharge in patients without subsequent rehabilitation, the mRs of rehabilitants was nearly identical after rehabilitation. Patients with good mRs also reached high levels of health-related quality of life (HRQoL) without rehabilitation. Thus, subsequent rehabilitation needs to be encouraged on an individual basis. Indication criteria for subsequent rehabilitation should be defined in further studies to improve patient treatment and efficiency in health care.
Highlights
Spontaneous subarachnoid hemorrhage (SAH) is usually caused by an aneurysm rupture of intracranial arteries vessels often associated with hypertensive blood pressure or innate malformations
Rehabilitation was identified as a positive prognostic outcome factor for NPM SAH [9]; we used the modified Rankin scale for short-term follow-up after six months and the SF-36 questionnaire to evaluate whether rehabilitation had an effect on long-term outcomes after PM SAH
A prospective long-term outcome evaluation was performed in patients with non-aneurysmal SAH
Summary
Spontaneous subarachnoid hemorrhage (SAH) is usually caused by an aneurysm rupture of intracranial arteries vessels often associated with hypertensive blood pressure or innate malformations. In about 25% of patients with spontaneous SAH, a bleeding source cannot be identified by radiological diagnostics [2,3]. An anatomical classification differentiates between perimesencephalic or prepontine (PM) and non-perimesencephalic (NPM) hemorrhage localization [4]. Data about short-term and long-term follow-up due to physical and mental health are scarce; this study reports these results [8]. Rehabilitation was identified as a positive prognostic outcome factor for NPM SAH [9]; we used the modified Rankin scale (mRs) for short-term follow-up after six months and the SF-36 questionnaire to evaluate whether rehabilitation had an effect on long-term outcomes after PM SAH
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