Subarachnoid haemorrhage and the life after

Abstract

Of all stroke patients 5% has a subarachnoid haemorrhage (SAH); a bleed in the space between the brain and the skull that contains blood vessels that supply the brain. Every year 9 per 100.000 patients have an SAH and half the patients are younger than 55 years old. In most instances (80%) the cause of the bleeding is a ruptured aneurysm and in 10% a perimesencephalic nonaneurysmal haemorrhage (PMH). Patients with a PMH have a good short term outcome. The cause of a PMH is probably a venous source. Aneurysmal SAH has a poor outcome: 35% dies in the first 4 weeks after the haemorrhage and 20% remains dependent for activities of daily life. Life expectancy is reduced after aneurysmal SAH, probably from an excess of other heart and vessel diseases. Chapter 2 describes the supplemental value of scrutinising the history of relatives to detect SAH and heart and vessel diseases in 1290 first degree and 3588 second degree relatives of a consecutively collected cohort of 163 patients with SAH. Almost half of the families with a positive history for SAH in a first or second degree relative would have been gone undetected without the information provided by scrutinising all individual relatives. In Chapter 3 we studied the feasibility of follow-up through e-mail in patients discharged after SAH. E-mail follow-up was easy to perform, comfortable for the patient or relative and less time-consuming than follow-up by telephone. However, only 60% of all included patients had an e-mail address and 21% of those patients changed once or more the e-mail address. In Chapter 4 we describe a long-term follow-up study to assess life expectancy in 160 patients with a PMH with a total number of patients-years of 1213. At time of follow-up (range 1 – 23 years) 149 patients were still alive. Patients with PMH have no excess in mortality compared with the general population. In Chapter 5 we studied anosmia after PMH. The presumed causes of anosmia after a ruptured aneurysmal SAH are the sudden intracranial arterial pressure or the presence of blood in itself. It is unknown whether anosmia can develop after a PMH. Nine of 148 included patients had noticed a loss of smell already during the clinical course. Two patients reported a complete recovery after 8 to 12 weeks. We found no relation between anosmia and risk factors such as age, sex or hydrocephalus. Chapter 6 describes long-term outcome of 92 patients discharged to a nursing home after SAH. After 2 years 28 (30%) of these patients were discharged home or to another facility and forty-four patients (43%) lived longer than 5 years. Chapter 7 is a continuation of a former study of quality of life 4 and 18 months after SAH. In that cohort of patients there was improvement of functional outcome measured in modified Rankin scale and quality of life measured in SF-36 and a VAS score. Overall there was still an improvement in quality of life, while functional outcome worsened between 5 and 12.5 years.