Long-term health outcomes of subarachnoid hemorrhage

Subarachnoid Hemorrhage (SAH) constitutes approximately 5% of all strokes (Longstreth, Koepsell, Yerby & van Belle, 1985) and affects 21,000-33,000 people every year in the United States (Rosamond et al., 2007). Though constituting only a small proportion of incident stroke cases, SAH has a higher case fatality than other stroke types with 28-day case fatality reported as 12% for ischemic stroke, 45% for intracerebral haemorrhage, 50% for SAH and 38% for stroke of undermined type (Thrift et al., 2001). In the absence of appropriate interventions, the number of deaths due to stroke worldwide is expected to rise to 6.5 million in 2015 and to 7.8 million in 2030 (Strong, Mathers & Bonita, 2007). As SAH outcomes tend to change overtime (Haug et al., 2007; Koivisto et al., 2000), studying SAH over time is important from the stand-point of better understanding its natural course and the impact of various management strategies. Studying long-term outcomes of SAH in a population based context is important, yet there are few population based studies of SAH survivors beyond 12 months (Hackett & Anderson, 2000) and even fewer examining wider outcomes such as neuropsychological outcomes, quality of life (Mocco et al., 2006), disability (Hop, Rinkel, Algra & van Gijn, 1997), and mood (Powell, Kitchen, Heslin & Greenwood, 2004). This chapter will review the existing literature on long-term (> 12 months) health outcomes of SAH with a focus on these less evidenced outcomes; including neuropsychological functioning, quality of life, and disability; placing these within the context of the WHO models of health