Abstract
ABSTRACT

Objective
To assess the impact of surgical treatment of ruptured cerebral aneurysms on physical and cognitive functioning of patients.
Patients and Methods
From January 2008 to May 2009, 18 patients operated for ruptured cerebral aneurysms at Shifa International Hospital Islamabad were included in this retrospective study. Admission assessment was done using Hunt-Hess grade. All patients were followed 3 and 12 months postoperatively with a thorough physical examination and clinical investigations. Functional independence measure (FIM) scale was used to assess the outcome.
Results
Of 18 patients, 14 (78%) were men, and 4(28%) were woman. The mean age was 34 years (range 28 to 58 years). Those who underwent clipping for ruptured cerebral aneurysms had reduced verbal memory; otherwise, they had improved cognitive function 12 months postoperatively.
Conclusion
Surgical clipping of cerebral aneurysms yielded optimal functional outcome despite having cognitive and psychological deficits. (Rawal Med J 2010;35: ).
Key words
Intracranial aneurysms, clipping, subarachnoid hemorrhage.

INTRODUCTION
Subarachnoid hemorrhage (SAH) is a most common presentation of intracranial aneurysms1and often has devastating outcome, if not treated in time.2 Most intracranial aneurysms remain asymptomatic until rupture, with only 10% presenting prior to rupture, usually with symptoms of mass effect.3 SAH accounts for 5%-10% of all strokes presenting in the 5th decade of life.4-7 After aneurysmal rupture, SAH causes diffuse neurotoxic damage to the exposed cerebrum.8 Subsequent vasospasm and ischemia may lead to the more local damage. Therefore, they never regain their previous mental and social well being and end up with some degree of cognitive and psychological deficit. 9-12 This impairment leads to difficulty with reintegration into the social environment often, despite the good functional physical outcome. The aim of this study was to determine the impact of surgical treatment of ruptured cerebral aneurysms on physical and cognitive functioning of these patients with extended follow up.


PATIENTS AND METHODS
All adult patients admitted to the Department of Neurosurgery and operated for aneurysmal SAH over a period of 16 months from January 2008 to May 2009 were included in this study. Data were gathered from the hospital records. Admission criteria were assessed using the Hunt-Hess five grade scale, describing the patient’s condition immediately after SAH. Clinical history, physical examination, CT and MRA confirmed the diagnosis of SAH due to a ruptured aneurysm. Aneurysms were treated microsurgical clipping with few having external ventricular drain (EVD) or ventriculo peritoneal shunting, if hydrocephalus developed. Functional status was assessed from admission to discharge to the subsequent follow up visits using the functional independence measure (FIM).5,13

The FIM grades from impairment to disability and correlates with

Key words: Intracranial aneurysms, clipping, subarachnoid hemorrhage.