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Behavior After Aneurysmal Subarachnoid Hemorrhage: Cognition and Functional Outcome

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The Behavioral Consequences of Stroke

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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).

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Authors and Affiliations

  1. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Timour Al-Khindi B.Sc.

  2. Division of Neurosurgery, St. Michael’s Hospital, Toronto, ON, Canada

    R. Loch Macdonald M.D., Ph.D.

  3. Department of Surgery, University of Toronto, Toronto, ON, Canada

    R. Loch Macdonald M.D., Ph.D.

  4. Neurological Intensive Care Unit, Columbia University Medical Center, New York, NY, USA

    Stephan Mayer M.D., F.C.C.M.

  5. Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, Canada, M5B 1W8

    Tom A. Schweizer Ph.D.

  6. Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada

    Tom A. Schweizer Ph.D.

  7. Heart and Stroke Foundation, Centre for Stroke Recovery, Toronto, ON, Canada

    Tom A. Schweizer Ph.D.

  8. Division of Neurosurgery, Department of Surgery, University of Toronto, St. Michael’s Hospital, Toronto, ON, Canada

    Tom A. Schweizer Ph.D.

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  1. Timour Al-Khindi B.Sc.
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  2. R. Loch Macdonald M.D., Ph.D.
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  3. Stephan Mayer M.D., F.C.C.M.
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  4. Tom A. Schweizer Ph.D.
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Editors and Affiliations

  1. University of Toronto Division of Neurosurgery, St. Michael’s Hospital Neuroscience Research Program, Toronto, Ontario, Canada

    Tom A. Schweizer

  2. University of Toronto Department of Surgery, St. Michael’s Hospital Division of Neurosurgery, Toronto, Ontario, Canada

    R. Loch Macdonald

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Al-Khindi, T., Macdonald, R.L., Mayer, S., Schweizer, T.A. (2014). Behavior After Aneurysmal Subarachnoid Hemorrhage: Cognition and Functional Outcome. In: Schweizer, T., Macdonald, R. (eds) The Behavioral Consequences of Stroke. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7672-6_10

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