Ljunggren B, Sonesson B, Säveland H, Brandt L
J Neurosurg. 1985 May;62(5):673-9. doi: 10.3171/jns.1985.62.5.0673.
The mortality rate has recently been reduced to only a small percentage of patients selected for early aneurysm surgery. Despite recovery without neurological deficits, however, a diffuse encephalopathy may remain, with emotional and psychological sequelae that will interfere with rehabilitation and social reintegration. The present study evaluates quality of life, degree of cognitive dysfunction, and adjustment of patients with a satisfactory neurological recovery after aneurysm operation in the acute stage following a major subarachnoid hemorrhage (SAH). Of 118 patients with a good neurological recovery, 40 patients were randomly sampled for a cross-sectional study and subjected to a questionnaire relating to their symptoms, a clinical interview, and a comprehensive neuropsychological investigation. The time interval between SAH and assessment varied between 14 months and 7 years, averaging 3 1/2 years. By means of standardized psychometric testing of intellectual capacity, memory functions, visuo-spatial abilities, perceptual speed and accuracy, and concept formation, degrees of cognitive impairment ranging from slight to severe dysfunction were identified. The results suggest that these disturbances may be permanent. The degree of impairment appeared to correlate with the patients' age. Interview data revealed substantial post-hemorrhagic maladjustment with respect to vitality, social management, self-assertion, emotional control, temperament, mood, and cognitive abilities. These findings were considerably at variance with the symptoms reported. It is stressed that, in the absence of gross neurological deficits, vital information on post-hemorrhage adjustment and impairment may easily be overlooked due to psychological defensive measures. It remains an open question whether post-SAH encephalopathy is enhanced by surgery performed in the acute stage.
近期，在接受早期动脉瘤手术的患者中，死亡率已降至很低的百分比。然而，尽管患者恢复后未出现神经功能缺损，但仍可能存在弥漫性脑病，并伴有情感和心理后遗症，这会干扰康复进程和重新融入社会。本研究评估了在重大蛛网膜下腔出血（SAH）急性期动脉瘤手术后神经功能恢复良好的患者的生活质量、认知功能障碍程度以及适应情况。在118例神经功能恢复良好的患者中，随机抽取40例进行横断面研究，并让他们填写一份关于症状的问卷，接受临床访谈以及全面的神经心理学调查。SAH与评估之间的时间间隔在14个月至7年之间，平均为3.5年。通过对智力、记忆功能、视觉空间能力、感知速度和准确性以及概念形成进行标准化心理测量测试，确定了从轻度到重度功能障碍的认知损害程度。结果表明，这些障碍可能是永久性的。损害程度似乎与患者年龄相关。访谈数据显示，患者在活力、社会管理、自我主张、情绪控制、气质、情绪和认知能力方面存在大量出血后的适应不良。这些发现与所报告的症状有很大差异。需要强调的是，在没有明显神经功能缺损的情况下，由于心理防御措施，关于出血后适应和损害的重要信息很容易被忽视。SAH后急性期中进行的手术是否会加重脑病，仍是一个悬而未决的问题。
