Biology Reference
In-Depth Information
There are also other issues that can infl uence outcome of the
treatment, the neurobehavioral effects of which remain unknown.
For instance, during the last 20 years, there has been increased
success of treatment of aneurysms by endovascular therapies that
lead to a decreased incidence of vasospasm. But most importantly,
there is a signifi cant increase of an incidental diagnosis of unrup-
tured aneurysms, like in the case of AB (
32-34
), because of genetic
studies as well as increased accessibility of CT/MRI. In the USA,
even the slightest suspicion of intracranial disease leads to CT/
MRI due to increased vigilance and awareness of symptoms of
stroke after the successful “Brain is time” and “Decade of the
brain” initiatives. This medically justifi able proactive attitude has
signifi cantly increased the number of patients whose aneurysms are
treated before they rupture (
34, 35
). All these new developments
have built new expectations from patients, their families, referring
physicians, and rehabilitation therapist, especially with regard to
outcome. Thus, it is clear that it is insuffi cient to assess only the
patient after aneurysm repair by the GOS or even QOL scales.
Patients and their families expect the patients' posttreatment status
to be adequately compared to “a state of complete physical, men-
tal, and social well-being.” These expectations are shared also by
the health providers building up a peer pressure to provide the
outcome information addressing not only physical, but also social,
behavioral, and economical aspects of life (
6, 13
).
4. Neurobehavioral
Changes After
Aneurismal SAH
Recent studies of neurobehavioralists and researchers, such as
Hutter et al. (
36
), have brought the problem of neuropsychologi-
cal consequences of aSAH to the forefront (
9, 13, 37
). Several
studies have addressed (Table
5
) this issue; nevertheless, no com-
prehensive and reliable conclusions can be drawn about the impact
of acute, delayed, or chronic changes evoked by aSAH on
neurobehavior.
Furthermore, most of these studies were focused on the pres-
ence of delayed vasospasm and its infl uence on neurobehavioral
outcome (
38, 40-43
). They showed that 30-50% of all patients
after aSAH suffer cognitive defi cits, especially when tested for
attention and memory (
44
), thus confi rming a signifi cant unfavor-
able effect of severe delayed cerebral vasospasm. But even the rela-
tively simple issue of memory defi cits in the setting of
arteriographically confi rmed delayed vasospasm after aSAH remains
controversial because others (
8, 39, 45
) have not confi rmed this
observation. Of course, and it is not a surprise, there is no informa-
tion about how early damage to the brain or endovascular and
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