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Table of Contents    
COMMENTARY
Year : 2021  |  Volume : 69  |  Issue : 2  |  Page : 342-343

Life after Subarachnoid Hemorrhage: Is Everything All Right?


Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission24-Mar-2021
Date of Decision24-Mar-2021
Date of Acceptance06-Apr-2021
Date of Web Publication24-Apr-2021

Correspondence Address:
Nishant Goyal
Department of Neurosurgery, All India Institute of Medical Sciences, Veerbhadra Road, Rishikesh - 249 203, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.314558

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How to cite this article:
Goyal N. Life after Subarachnoid Hemorrhage: Is Everything All Right?. Neurol India 2021;69:342-3

How to cite this URL:
Goyal N. Life after Subarachnoid Hemorrhage: Is Everything All Right?. Neurol India [serial online] 2021 [cited 2021 May 9];69:342-3. Available from: https://www.neurologyindia.com/text.asp?2021/69/2/342/314558




The present article puts the spotlight on the quality of life (QoL) of patients who underwent treatment of aneurysmal subarachnoid hemorrhage (aSAH).[1] Out of the patients who were alive and could be followed up at 3 months, few patients had a severe disability and 95% of the patients could resume their activities of daily living. At first, these figures may seem very comforting to the treating neurosurgeon. However, the authors stated that a majority of their patients had a deteriorated QoL with almost 40% unable to resume their previous work/employment. The authors also noted that of the eight components of the SF-36 (36-Item Short Form Survey) for determining the QoL, the worst affected were the mental health domain in 81.1%, vitality and general health perception in almost 60%, and physical functioning in 56.6%. Physical pain and physical and emotional role were comparatively less affected. Many patients were found to have a significant neurocognitive and neuropsychological impairment.

aSAH accounts for 5% of all strokes and has an exceptionally high disease-specific burden. Almost half of the patients are younger than 55 years, one third die within the initial days to weeks after bleed, and most survivors have long-term cognitive impairment.[2] At the community level, the magnitude of loss of productive life-years after SAH is similar to that of ischemic stroke. Generally, neurosurgeons have a tendency to see the patients as “all or none.” Everything is considered fine by the operating neurosurgeon/neurointerventionist unless there is mortality or a major disability. We often feel satisfied to see a well-clipped/coiled aneurysm on the check DSA (digital subtraction angiography), but often forget to pay attention to how that patient is doing as a “person.”

In another similar study, Hop et al.[3] found similar results with an adverse effect on the QoL of patients treated for aSAH. Importantly, they also found that QoL of the patients' partners was also affected adversely, most prominently in the psychosocial domains. Many partners reported feelings of anxiety and being afraid to leave the patient alone. Some patients and their partners became fearful of having sex, especially in cases where the patient had a coital SAH. Another study reported almost half of the SAH survivors to be suffering from depression, which was found to be associated with poor QoL.[4] In a study by Hütter et al.,[5] QoL was reduced in SAH patients along with a decline in life satisfaction and increased emotional lability. Almost 30% suffered a loss of job/demotion or had been retired.

In this article, it was observed that the neurological status at presentation and at discharge along with hospital course, treatment modality, and clinical vasospasm were predictors of QoL after aneurysmal SAH. Other factors such as age, gender, aneurysmal location, aneurysmal size, and radiological severity of SAH, measured by modified Fisher's scale, did not seem to predict the QoL.[1] Wong et al.[6] observed that patients of SAH demonstrated a decline in QoL according to SF-36 at 6 months. In their study, the physical component scores were related to age, WFNS (World Federation of Neurological Surgeons) grade, and chronic hydrocephalus.

We tend to ignore the way in which the life of the patient and their family is affected after suffering from an aneurysmal bleed. The present study discusses this often-ignored aspect of aSAH and reminds us to treat the patient as a whole and not merely as an imaging.



 
  References Top

1.
Kulkarni AV, Devi BI, Konar SK, Shukla D. Predictors of Quality of life at 3 Months after Treatment for Aneurysmal Subarachnoid Hemorrhage. Neurol India 2021;69:336-344.  Back to cited text no. 1
  [Full text]  
2.
Etminan N, Chang H-S, Hackenberg K, de Rooij NK, Vergouwen MDI, Rinkel GJE, et al. Worldwide incidence of aneurysmal subarachnoid hemorrhage according to region, time period, blood pressure, and smoking prevalence in the population. JAMA Neurol 2019;76:588-97.  Back to cited text no. 2
    
3.
Hop JW, Rinkel GJE, Algra A, van Gijn J. Quality of life in patients and partners after aneurysmal subarachnoid hemorrhage. Stroke 1998;29:798-804.  Back to cited text no. 3
    
4.
Kreiter KT, Rosengart AJ, Claassen J, Fitzsimmons BF, Peery S, Du YE, et al. Depressed mood and quality of life after subarachnoid hemorrhage. J Neurol Sci 2013;335:64-71.  Back to cited text no. 4
    
5.
Hütter BO, Gilsbach JM, Kreitschmann I. Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg 1995;9:465-76.  Back to cited text no. 5
    
6.
Wong GKC, Poon WS, Boet R, Chan MTV, Gin T, Ng SCP, et al. Health-related quality of life after aneurysmal subarachnoid hemorrhage: Profile and clinical factors. Neurosurgery 2011;68:1556-61.  Back to cited text no. 6
    




 

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