Cerebral vasospasm and health-related quality of life after subarachnoid hemorrhage

Abstract

Objective: To examine the influence of cerebral vasospasm on health-related quality of life after subarachnoid hemorrhage. An additional objective was to determine how the timing of nimodipine therapy can influence health-related quality of life.

Methods: Patients treated between 1998 and 2008 for nontraumatic subarachnoid hemorrhages were sent a standardized questionnaire for the purposes of documenting their health-related quality of life. Initially the patients were divided into two groups: those with and those without cerebral vasospasm after hemorrhage (radiologically confirmed). They were then differentiated according to four types of treatment options for vasospasm: 1) nimodipine since admission (N = 179); 2) nimodipine since diagnosis of vasospasm (N = 14); 3) no nimodipine/no vasospasm (N = 34); and 4) no nimodipine despite vasospasm (N = 5). Significance was established as P ≤ 0.05.

Results: Evaluable questionnaires were returned by 236 patients (68% women, mean age 56.35 ± 12.68 years; 32% men, mean age 54.57 ± 12.20 years). Health-related quality of life generally appeared to be impaired. Yet with the exception of the subscale (1 of 8) of physical role (P = 0.019), there were no differences between patients with and without vasospasm. Variations in the different treatment options revealed significant effects in terms of the component summaries and subscales: physical role and pain, general health, vitality, social functioning, emotional role, mental health, and mental component summary (P ≤ 0.04).

Conclusions: Cerebral vasospasm had little influence on health-related quality of life in our patient population. Health-related quality of life cannot be used as the only argument in favor of treating cerebral vasospasm with nimodipine.

Keywords: CT; Calcium antagonists; Computed tomography; Health-related quality of life; MOS-36 Item Short Form Health Survey; MRI; Magnetic resonance imaging; Nimodipine; QUASCH; Questionnaire on subarachnoid hemorrhage; SF-36; Subarachnoid hemorrhage.