Decompressive Hemicraniectomy for Poor-grade Aneurysmal Subarachnoid Hemorrhage Patients with Associated Intracerebral Hemorrhage: Clinical Outcome and Quality of Life Assessment

Abstract OBJECTIVE: Decompressive hemicraniectomy has been proposed as a potential treatment strategy in patients with poor-grade aneurysmal subarachnoid hemorrhage presenting with focal intracerebral hemorrhage causing significant mass effect. Although hemicraniectomy improves overall survival rates, the long-term quality of life (QoL) for survivors in this patient population has not been reported. METHODS: Using adjudicated outcome assessments, we compare long-term clinical outcomes and QoL between a group of patients with poor-grade aneurysmal subarachnoid hemorrhage receiving decompressive hemicraniectomy (n = 12) and a control group of similar patients managed more conservatively (n = 10). RESULTS: Patients receiving decompressive hemicraniectomy experienced a statistically insignificant decrease in short-term mortality compared with controls (25 versus 42%); however, long-term QoL in hemicraniectomy survivors was generally poor. Furthermore, hemicraniectomy patients did not experience an increase in mean quality-adjusted life years over control patients (2.31 versus 2.22 yr). CONCLUSION: Decompressive hemicraniectomy prolongs short-term survival in patients with poor-grade aneurysmal subarachnoid hemorrhage with associated intracerebral hemorrhage; however, this trend is not statistically significant, and the overall QoL experienced by survivors is poor. Decompressive hemicraniectomy may be indicated if performed early in a select subset of patients. On the basis of our preliminary data, large prospective studies to investigate this issue further may not be warranted.

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Predictors of long-term Health-Related Quality of Life in patients with aneurysmal subarachnoid hemorrhage

Neurorehabilitation ◽

10.3233/nre-2012-0737 ◽

2010 ◽

Vol 30 (2) ◽

pp. 137-145 ◽

Cited By ~ 18

Author(s):

P.E.C.A. Passier ◽

J.M.A. Visser-Meily ◽

M.J.E. van Zandvoort ◽

G.J.E. Rinkel ◽

E. Lindeman ◽

...

Keyword(s):

Quality Of Life ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Long-term Neuropsychiatric and Neuropsychological Sequelae of Endovascularly Treated Aneurysmal Subarachnoid Hemorrhage

Acta Médica Portuguesa ◽

10.20344/amp.10894 ◽

2019 ◽

Vol 32 (11) ◽

pp. 706

Author(s):

Lídia Sousa ◽

Ana Antunes ◽

Tiago Mendes ◽

Sofia Reimão ◽

Lia Lucas Neto ◽

...

Keyword(s):

Quality Of Life ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Neuropsychiatric Symptoms ◽

Health Related Quality ◽

Related Quality ◽

Health Related

Introduction: There is limited evidence regarding long-term outcomes of aneurysmal subarachnoid hemorrhage survivors. Most follow-up programs are relatively short and focused on physical functions. Endovascular aneurysmal embolization enables recovery of normal vascular architecture. However, there is growing evidence that neuropsychological and behavior sequelae can significantly impact the lives of these patients, even when treatment is successful. In this study, we reviewed cognition, psychiatric and neuropsychological symptoms, global functionality, and health-related quality of life 10 to 12 years after an aneurysmal subarachnoid hemorrhage.Material and Methods: A cross-sectional observational study was carried out in a university hospital. All cases of aneurysmal subarachnoid hemorrhage admitted between January 2004 and December 2006 and endovascularly treated were reviewed. Participants underwent a neuropsychological evaluation and a clinical interview with a psychiatrist.Results: Fourteen patients participated in the study. Almost 70% (n = 10) showed cognitive impairment; in more than 40% (n = 6) of the subjects, significant symptoms of anxiety were identified, and 35% (n = 5) were classified as having clinical depression. Relevant posttraumatic symptoms were reported by more than 70% (n = 10) of patients, and almost 30% (n = 4) showed other moderate neuropsychiatric symptoms. Overall, health-related quality of life was impaired, and personality changes were frequently reported by the participants and their relatives.Discussion: A significant prevalence of ongoing deficits in high-level functioning and reduced health-related quality of life were observed in a sample of young and professionally active individuals that were successfully treated and discharged from follow-up consultations.Conclusion: There is a need for better follow-up strategies, targeting more subtle deficits and psychological symptoms after aneurysmal subarachnoid hemorrhage.

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Long-term reintegration and quality of life in patients with subarachnoid hemorrhage and a good neurological outcome: findings after more than 20 years

Journal of Neurosurgery ◽

10.3171/2016.11.jns16805 ◽

2018 ◽

Vol 128 (3) ◽

pp. 785-792 ◽

Cited By ~ 13

Author(s):

Bengt Sonesson ◽

Erik Kronvall ◽

Hans Säveland ◽

Lennart Brandt ◽

Ola G. Nilsson

Keyword(s):

Quality Of Life ◽

Subarachnoid Hemorrhage ◽

Sleep Disturbances ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Well Being ◽

Neurological Recovery ◽

Original Cohort ◽

Quality Of Life Scale

OBJECTIVEThe goal of this study was to examine long-term quality of life (QOL) and reintegration in patients with good neurological recovery after aneurysmal subarachnoid hemorrhage (aSAH) and SAH of unknown cause (SAH NUD).METHODSA long-term follow-up was performed in an original cohort of 113 individuals who had suffered SAH (93 with aSAH and 20 with SAH NUD) between 1977 and 1984. Self-reporting assessments, performed > 20 years after the bleeding episode, included the Quality of Life Scale (QOLS), Psychological General Well-Being (PGWB) index, and Reintegration to Normal Living (RNL) index, along with information on sleep disturbances and work status.RESULTSSeventy-one survivors were identified. Questionnaires were returned by 67 individuals who had suffered SAH 20–28 years previously. The QOL was rated in the normal range for both the QOLS score (aSAH 90.3 vs SAH NUD 88.6) and the PGWB index (aSAH 105.9 vs SAH NUD 102.8). Ninety percent of patients had returned to their previous employment. Complete RNL was reported by 40% of patients with aSAH and by 46% of patients with SAH NUD; mild to moderate readjustment difficulties by 55% and 38%, respectively; and severe difficulties by 5% of patients with aSAH and 15% of patients with SAH NUD. Self-rated aspects of cognition, mood, and energy resources in addition resulted in a substantial drop in overall reintegration. Sleep disturbances were reported by 26%.CONCLUSIONSMore than half of patients with SAH who had early good neurological recovery experienced reintegration difficulties after > 20 years. However, the general QOL was not adversely affected by this impairment. Inability to return to work after SAH was associated with lower QOLS scores. Sleep disturbances were associated with lower PGWB scores.

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Relation of gray-white matter ratio with long-term cognitive functions and quality of life in patients with mild to moderate aneurysmal subarachnoid hemorrhage: a prospective observational study

Acta Neurochirurgica ◽

10.1007/s00701-017-3374-y ◽

2017 ◽

Vol 160 (1) ◽

pp. 181-189 ◽

Cited By ~ 1

Author(s):

Achmet Ali ◽

Gamze Tanirgan ◽

Pulat Akin Sabanci ◽

Nukhet Sivrikoz ◽

Taner Abdullah ◽

...

Keyword(s):

Quality Of Life ◽

Subarachnoid Hemorrhage ◽

White Matter ◽

Observational Study ◽

Cognitive Functions ◽

Prospective Observational Study ◽

Aneurysmal Subarachnoid Hemorrhage

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Abstract P831: Use of the Neuro-QoL Measures for Assessment of Contributors to Long-Term Quality of Life, Post-Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.52.suppl_1.p831 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Kayla Wynja ◽

Drew Prescott ◽

Brandon Baughman ◽

Anne W Alexandrov ◽

Xueyuan Cao ◽

...

Keyword(s):

Quality Of Life ◽

Subarachnoid Hemorrhage ◽

Social Roles ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Self Report ◽

Fine Motor ◽

Lower Extremity Function ◽

Extremity Function

Background: Aneurysmal subarachnoid hemorrhage (aSAH) survivors are at high risk for poor quality of life (QoL). Standard outpatient neurologic assessment may not capture some affective and cognitive factors important for long-term QoL, and reintegration into normal social roles. The purpose of this study is to determine the utility of the Quality of Life in Neurological Disorders (Neuro-QoL) measures for assessment of such factors in nursing practice. Methods: Standard demographic and clinical characteristics were collected on patients >1 year post-aSAH, along with self-report information on seven Neuro-QoL measures (Ability to Participate in Social Roles and Activities [ABL]; Satisfaction with Social Roles and Activities [SATIS]; Cognitive Function [COG]; Depression [DEP]; Anxiety [ANX]; Lower Extremity Function - Mobility [LE] & Upper Extremity Function - Fine Motor [UE]). Scores are T-scores with mean 50(±10). Associations were determined using Spearman correlations or paired t-tests as appropriate. Results: Participants (N=35) were 48.6(±12.5) years, 4.7(±3.6) years post aSAH, 80% female, 65.7% African American, and mean Hunt Hess Grade 2.3(±0.8). Age, race, and gender were not associated with Neuro-QoL outcomes. Our average sample T-scores were: ABL=45.3; SATIS=47.6; COG=44.3; DEP=49.3; ANX=51.3; LE=46.5; UE=46.7. COG was associated with ABL and SATIS ( p <0.02). ANX was associated with ABL ( p =0.02). UE and LE were associated with ABL (r=0.5, p =0.001; r=0.8, p <0.0001, respectively) and SATIS (r=0.5, p =0.005; r=0.8, p <0.0001). Conclusions: The Neuro-QoL measures provide an effective tool for nursing assessment of QoL in post-aSAH. Although physical disability impairs social integration, we also found that cognitive and anxiety symptoms uniquely influenced the ability to integrate into social roles and may reduce overall QoL.

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Long-Term Health-Related Quality of Life After Aneurysmal Subarachnoid Hemorrhage

Stroke ◽

10.1161/strokeaha.108.531277 ◽

2009 ◽

Vol 40 (4) ◽

pp. 1526-1529 ◽

Cited By ~ 105

Author(s):

J.M. Anne Visser-Meily ◽

Marloes L. Rhebergen ◽

Gabriel J.E. Rinkel ◽

Martine J. van Zandvoort ◽

Marcel W.M. Post

Keyword(s):

Quality Of Life ◽

Subarachnoid Hemorrhage ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Long-Term Effectiveness of Fingolimod for Multiple Sclerosis in a Real-World Clinical Setting

European Neurology ◽

10.1159/000514828 ◽

2021 ◽

pp. 1-6

Author(s):

Cihat Uzunköprü ◽

Yesim Beckmann ◽

Sabiha Türe

Keyword(s):

Quality Of Life ◽

Multiple Sclerosis ◽

Real Life ◽

Life Assessment ◽

Health Related Quality ◽

Serious Adverse Events ◽

Related Quality ◽

Health Related

Introduction: The primary aim of the present study was to evaluate the long-term efficacy of fingolimod in patients with multiple sclerosis (MS); secondary aims were to describe the safety of fingolimod with the evaluation of treatment satisfaction and impact on the quality of life in real life. Methods: We collected clinical, demographical, neuroradiological, and treatment data, including pre- and posttreatment status health-related quality of life from 286 MS patients consecutively treated with fingolimod. Clinical assessment was based on the Expanded Disability Status Scale (EDSS), and quality of life assessment was performed with MS-related quality of life inventory (MSQOLI). The data were recorded at baseline and every 6 months for 2 years. Results: One hundred and fourteen males and 172 females were enrolled. The annualized relapse rate and EDSS showed a statistically significant reduction during the observation period (p < 0.001). The patients also demonstrated substantial improvements in magnetic resonance imaging (MRI) outcomes (p < 0.001). Health-related quality of life scores improved significantly between baseline and 24-month visit (p < 0.001). No serious adverse events occurred. Conclusion: In our cohort, fingolimod treatment was associated with reduced relapse, MRI activity, and improved EDSS and MSQOLI scores. Additionally, fingolimod has been able to maintain its effectiveness over a considerable long period of treatment.

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