医学
脑出血
自发性脑出血
心情
观察研究
自然史
重症监护医学
冲程(发动机)
生活质量(医疗保健)
精神科
蛛网膜下腔出血
内科学
机械工程
护理部
工程类
作者
Lourdes Carhuapoma,Santosh B. Murthy,Vishank Shah
出处
期刊:Seminars in Neurology
[Georg Thieme Verlag KG]
日期:2024-05-24
卷期号:44 (03): 298-307
标识
DOI:10.1055/s-0044-1787104
摘要
Abstract Spontaneous intracerebral hemorrhage (ICH) is the most morbid of all stroke types with a high early mortality and significant early disability burden. Traditionally, outcome assessments after ICH have mirrored those of acute ischemic stroke, with 3 months post-ICH being considered a standard time point in most clinical trials, observational studies, and clinical practice. At this time point, the majority of ICH survivors remain with moderate to severe functional disability. However, emerging data suggest that recovery after ICH occurs over a more protracted course and requires longer periods of follow-up, with more than 40% of ICH survivors with initial severe disability improving to partial or complete functional independence over 1 year. Multiple other domains of recovery impact ICH survivors including cognition, mood, and health-related quality of life, all of which remain under studied in ICH. To further complicate the picture, the most important driver of mortality after ICH is early withdrawal of life-sustaining therapies, before initiation of treatment and evaluating effects of prolonged supportive care, influenced by early pessimistic prognostication based on baseline severity factors and prognostication biases. Thus, our understanding of the true natural history of ICH recovery remains limited. This review summarizes the existing literature on outcome trajectories in functional and nonfunctional domains, describes limitations in current prognostication practices, and highlights areas of uncertainty that warrant further research.
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