Article

The aim of the study was to assess the relation between
cerebrovascular function early after aneurysmal subarachnoid hemorrhage onset and
functional and rehabilitation outcomes. DESIGN: Observational cohort study of
subarachnoid hemorrhage patients (n = 133) admitted to rehabilitation (n = 49),
discharged home (n = 52), or died before discharge (n = 10). We obtained
hemodynamic markers of cerebral autoregulatory function from blood flow
velocities in the middle cerebral artery and arterial pressure waveforms,
recorded daily on days 2-4 after symptom onset, and functional independence
measure (FIM) scores and FIM efficiency for those admitted to acute
rehabilitation. RESULTS: Compared to those discharged home, the range of
pressures within which autoregulation is effective was lower in patients admitted
to rehabilitation (4.6 [0.2] vs. 3.9 [0.2] mm Hg) and those who died (2.7 [0.4],
P = 0.04). For those admitted to rehabilitation, autoregulatory range and the
ability of cerebrovasculature to increase flow were related to discharge FIM
score (R = 0.33 and 0.43, P < 0.01) and efficiency (R = 0.33 and 0.47 P < 0.01).
The latter marker, along with subarachnoid hemorrhage severity and admission FIM,
explained 84% and 69% of the variability in discharge FIM score and efficiency,
respectively, even after accounting for age. CONCLUSIONS: Early cerebrovascular
function is a major contributor to functional outcomes after subarachnoid
hemorrhage and may represent a modifiable target to develop therapeutic
approaches. TO CLAIM CME CREDITS: Complete the self-assessment activity and
evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon
completion of this article, the reader should be able to: (1) Define cerebral
autoregulation; (2) Explain the importance of the integrity of cerebral
autoregulation for longer-term functional and rehabilitation outcomes after
aneurysmal subarachnoid hemorrhage; and (3) Theorize why treatment strategies
that may be effective in reducing large-vessel vasospasms after an aneurysmal
subarachnoid hemorrhage might not always translate into improved functional
outcomes. LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists
is accredited by the Accreditation Council for Continuing Medical Education to
provide continuing medical education for physicians.The Association of Academic
Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA
PRA Category 1 Credit(s). Physicians should only claim credit commensurate with
the extent of their participation in the activity.

Langue : ANGLAIS