Problems of rehabilitation of patients after SAH
According to general clinical experience, six months after aneurysm surgery functional recovery has progressed so far that this clinical state corresponds for the most part to the endpoint of clinical recovery. Essen et al. (1991) found a complex recovery curve which did not point unequivocally to the direction of functional improvement in patients after rupture and surgical repair of an intracranial aneurysm. However, also the process of functional recovery after traumatic brain injury seems to exhibit complex traits of the clinical course and, moreover, the significance of individual prognostic factors has not been elucidated fully so far (Levin, Grafman and Eisenberg, 1987). Kertesz and McCabe (1977) studied the course of functional recovery in logopedically untreated as well as treated aphasics. In the total study sample of 93 aphasics, there were also 12 patients after SAH. With respect to prognosis and functional recovery, considerable differences were found between the etiological groups. The pattern of the clinical course of aphasics due to SAH exhibited a large variability in the progression of clinical recovery. Furthermore, the clinical course was more unfavorable than in those patients with aphasia due to traumatic brain injury. The clinical course was rather comparable to that of patients with cerebral infarctions. Especially the rupture of a left-sided MCA aneurysm oftentimes led to severe and persisting aphasias according to the results of Kertesz and McCabe (1977). Artiola and Fortuny (1978) found the most pronounced improvement of cognitive deficits in patients after aneurysm rupture in the immediate postoperative phase. Afterwards, Artiola and Fortuny (1978) observed only slight improvements. McKenna et al. (1989b) investigated 83 patients in a prospective longitudinal study at discharge from hospital as well as three months and one year after the acute event by means of a neuropsychological test battery and a semi-structured interview pertaining to problems in daily life. At the time of discharge, most patients exhibited cognitive deficits, but already at follow-up three months later the cognitive level of performance had improved considerably. After one year none of the neurologically intact patients exhibited a cognitive deficit (McKenna et al., 1989b). In a further study Richardson (1991) found statistically significant improvements in spatial cognition and a vocabulary test in SAH patients.
KeywordsTraumatic Brain Injury Cognitive Deficit Intracranial Aneurysm Aneurysm Rupture Prospective Longitudinal Study
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