OUR CASE
When sedation was ceased her neurological exam had improved and she was extubated.
With supportive care, Katherine made significant progress and was discharged to the neurosurgical ward several days later.
Patient outcomes
Factors Associated with a poor prognosis
WFNS
The strongest predictor of long-term outcome is the severity of clinical presentation (i.e. WFNS grade)
AGE
Particularly those >70 years of age
OTHER FACTORS
> Patient co-morbidities
> Large aneurysm size
> Location of aneurysm (including basilar artery aneurysm)
> Re-bleeding: the major complication in patients treated without surgery (20% risk in the first 2 weeks),
> Other Complications in hospital: seizures, cerebral oedema, delayed cerebral ischaemia, anaemia etc
Residual deficits for survivors
Again, depends often depends on the severity of clinical presentation
Approximately 1/3 survivors will have moderate to severe disability and not regain functional independence
Survivors with minimal/no physical impairment will often experience
- Cognitive impairment including problems with memory, concentration, or executive function
- Mood disturbances, including depression and PTSD
- Fatigue
- Anosmia
- Inability to return to work (1/3 nil work, 1/3 reduced hours/duties, 1/3 normal at 2-4 yrs)
Long term studies suggest that the overall quality of life tends to improve over the following years, despite a decreased functional outcome.
Follow Up
Family screening
Inheritence of aneurysms well estalibised for disordres including PCKD, MFS, Ehlers-Danlos
Family history also strong factor for patients with aSAH
Siblings have higher risk than children
Indications for screening of asymptomatic relatives is controversial for many reasons
- Negative studies do no guarantee that future imaging wont reveal an anerusym
- Cerebral imaging is expensive
- Burden to patients
- Overtreatment / investigation may increase harm
Family screening of first degree relatives is often considered when patients have two or more family members with intracranial aneurysms or a SAH
Multiple aneurysms
Approximately 25% patients will have multiple aneurysms.
If these are not treated at the time then further follow up with repeat imaging +/- intervention is often required.
This is because it is not always easy to determine which aneurysm caused the initial bleed.