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Behavior After Aneurysmal Subarachnoid Hemorrhage: Cognition and Functional Outcome

  • Timour Al-Khindi
  • R. Loch Macdonald
  • Stephan Mayer
  • Tom A. SchweizerEmail author
Chapter

Abstract

Spontaneous subarachnoid hemorrhage (SAH) is a medical emergency characterized by hemorrhage in the subarachnoid space surrounding the brain. In the vast majority of cases (85 %), spontaneous SAH is caused by the rupture of a cerebral aneurysm (aSAH) [1]. The other 15 % are idiopathic and two-thirds of these have a characteristic appearance on computed tomography (CT) and are called benign perimesencephalic SAH (pSAH). The characteristic sign of aSAH is a sudden onset of severe “thunderclap” headache, but patients may also present with vomiting, nausea, photophobia, and nuchal rigidity [2]. A cranial CT scan demonstrates accumulation of blood in the basal cisterns (see Fig. 10.1); patients may also present with hemorrhage into the brain and ventricular system [2]. Hypertension and cigarette smoking are risk factors for aSAH [3]. Although uncommon—the incidence of aSAH in North America is approximately 8–11 per 100,000 persons per year [4, 5]—aSAH carries a poor prognosis, with only 35 % of patients surviving [6, 7]. Indeed, although aSAH accounts for only 7 % of all strokes [8], it is responsible for 27 % of all stroke-related years of life lost before age 65 [9]. The high mortality after aSAH may be partially attributed to misdiagnosis. Up to 50 % of cases are misdiagnosed as migraine or tension-type headache due to failure to obtain lumbar puncture or proper neuroimaging [2]. Despite these statistics, advances in the acute management of aSAH over the past 3 decades—mainly increased use of vascular imaging, reduced delays to treatment, and better acute care management [7]—have substantially reduced mortality after aSAH. In a meta-analysis, Lovelock et al. [7] observed that, while the incidence of aSAH has remained stable over the past 30 years, mortality has been reduced by half and the 30-day case fatality rate has decreased by 0.9 % per annum (Figs. 10.1 and 10.2).

Keywords

Executive Function Verbal Memory Visual Memory Glasgow Outcome Scale Executive Dysfunction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Timour Al-Khindi
    • 1
  • R. Loch Macdonald
    • 2
    • 3
  • Stephan Mayer
    • 4
  • Tom A. Schweizer
    • 5
    • 6
    • 7
    • 8
    Email author
  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Division of NeurosurgerySt. Michael’s HospitalTorontoCanada
  3. 3.Department of SurgeryUniversity of TorontoTorontoCanada
  4. 4.Neurological Intensive Care UnitColumbia University Medical CenterNew YorkUSA
  5. 5.Keenan Research Centre, Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  6. 6.Institute of Biomedical EngineeringUniversity of TorontoTorontoCanada
  7. 7.Heart and Stroke Foundation, Centre for Stroke RecoveryTorontoCanada
  8. 8.Division of Neurosurgery, Department of SurgeryUniversity of Toronto, St. Michael’s HospitalTorontoCanada

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