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Prevalence of spasticity after aneurysmal subarachnoid haemorrhage
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
2014 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 1, 23-27 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The prevalence of spasticity after stroke is approximately 20%. There is, so far, little information in the literature on the development of spasticity after aneurysmal subarachnoid haemorrhage. The objectives of this study were to estimate the prevalence of spasticity after aneurysmal subarachnoid haemorrhage and to identify possible risk factors in the acute phase. Methods: A total of 87 patients were assessed for spasticity with the Modified Ashworth Scale after 6 months. A multivariate logistic regression model was used to evaluate risk factors. Results: Spasticity was present after 6 months in 19 (22%) of the patients, but was treated pharmacologically in only 1 case. Worse clinical status at admission carried a high risk for spasticity (odds ratio (OR) 10.2; 95% confidence interval (CI) 2.4-43.2), followed by the presence of infection (OR 7.4; 95% CI 1.6-33.8) and vasospasm (OR 4.8; 95% CI 1.2-19.0) during the intensive care phase. Conclusion: Spasticity after aneurysmal subarachnoid haemorrhage occurred with the same prevalence as after other stroke. Risk factors for spasticity were worse clinical condition at admission and the occurrence of infection and vasospasm during the intensive care period. Pharmacological treatment was not commonly used.

Place, publisher, year, edition, pages
2014. Vol. 46, no 1, 23-27 p.
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-218699DOI: 10.2340/16501977-1229ISI: 000330421800004PubMedID: 24201997OAI: oai:DiVA.org:uu-218699DiVA: diva2:696692
Available from: 2014-02-14 Created: 2014-02-14 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Life after Subarachnoid Hemorrhage
Open this publication in new window or tab >>Life after Subarachnoid Hemorrhage
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating disease with mean age of 59 years. SAH accounts for 5% of all stroke and more than one quarter of potential life years lost through stroke. With the advanced neurosurgical methods of today two thirds of the patients survive. We know, however, that various cognitive, psychiatric and physical impairments are common that affect quality of life, social life, and the ability to work in the aftermath of SAH. The overall aim constituting this PhD dissertation is to better understand some of the challenges often faced by those surviving SAH.

Two SAH patient cohorts have been studied. The first followed 96 consecutively included patients during the first year after ictus. Spasticity and cognitive impairment was assessed after 6 months and the Swedish stroke register follow-up form was used to investigate family support and the use of medical and social services. Return to work was assessed at 12 months. The second cohort assessed attention deficits using the test of variables of attention (T.O.V.A.) at 7 months after ictus in 19 patients with moderate to good recovery.

Spasticity was just as common in our SAH patients as after other stroke, though it was rarely treated pharmacologically. By assessing cognitive impairment at 6 months after ictus using the Montreal cognitive assessment, 68% of the patients could be correctly predicted as having returned/not returned to work at 12 months. Seventeen percent of the patients had not had a follow-up appointment 6 months after ictus. These patients were older, more often living alone, had a lower quality of life, more depressive symptoms and more cognitive impairment compared to those having had a follow-up appointment. Twenty percent had had a follow-up in primary care. Seventy-eight percent of those with moderate to severe disability were living in their own accommodations. Fifty-eight percent of the patients had attention deficits. Challenges after SAH were common and often dealt with in the home environment of the patients.

The results of this thesis highlight the importance of assisting the patients and their relatives in their struggle back to life after SAH.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. 97 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1281
Keyword
Aneurysmal, Attention deficit, Cognitive impairment, Family medicine, Follow-up appointments, General practice, Intracranial aneurysm, Outcome, Primary care, Primary health care, Return to work, Spasticity, Stroke, Subarachnoid hemorrhage, Sweden
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-307949 (URN)978-91-554-9762-0 (ISBN)
Public defence
2017-01-13, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskjölds väg 20, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2016-12-20 Created: 2016-11-23 Last updated: 2016-12-20

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Wallmark, SvanteRonne-Engström, Elisabeth

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