| Cognitive and Executive Function |
| Cognitive and executive functions include the following interrelated processes: Attention – The abilities to focus, shift, divide, or sustain attention on a particular stimulus or task or range of tasks. Memory – the ability to recall in the short or long-term and the recognition of visual and verbal information, be it about experiences (episodic) or meaning (semantic). Executive Function – involved in planning, abstract thinking, organization of thoughts, inhibition, conflict monitoring and multi-tasking. Perception – includes both auditory and visuospatial ability. Auditory perception includes dealing with crowded places or focusing where there is a lot of background noise. Visuospatial ability is the aptitude to visually search or scan for information, to draw or recreate visual images, and mentally manipulate objects two- and three-dimensional objects. Language – the ability to express and be receptive to language through speech, writing and reading comprehension across any of an individual’s languages. Cognitive processing – includes the volume and speed of information processing and motor reaction time. |
| Health Related Quality of Life |
| Health-related Quality of Life is a term referring to the health aspects of quality of life, which reflects the impact of subarachnoid hemorrhage and its treatment on broad concepts of an individual’s physical, psychological and social functioning and well-being including any financial impact. It has also been considered to reflect the impact of perceived health on an individual’s ability to live a fulfilling and purposeful life. |
| Functional Outcomes |
| Functional outcomes refer to aspects of general life and day-to-day function that may be impacted because of subarachnoid hemorrhage-related impairments. This can be thought of along a scale from basic activities of daily living, through instrumental activities of daily living and mobility, and onto social, professional, and family life. Basic abilities including: – Completing activities of daily living or essential to an individual’s personal care, such as getting into and out of bed and chairs, dressing, eating, toileting and bathing, and grooming. – The ability to walk with or without assistance or the ability to walk independently. Instrumental abilities include: – Completing activities essential to an individual’s ability to function autonomously, including cooking, doing laundry, taking care of a home, managing money, shopping, getting to places beyond walking distance. Social role performance abilities: – Work, previous role in the household, social and family life) at any capacity (e.g., same workload, reduced workload, etc.). The degree to which an individual can return to pre-hemorrhage baseline function on their journey of recovery. |
| Survival |
| Survival is being alive at a given timepoint after a subarachnoid hemorrhage. |
| Rebleeding and Aneurysm Obliteration |
| Re-bleeding: A distinct second instance of bleeding from a cerebral aneurysm (before, during or after treatment of the aneurysm). Aneurysm obliteration: Complete angiographic occlusion (e.g., clipping, coiling, etc.) resulting in elimination of a cerebral aneurysm from cerebral circulation. GLOSSARY: – Aneurysm: is a bulge in a blood vessel caused by a weakness in the blood vessel wall, usually where it branches. – Angiographic: To do with the health of your blood vessels and how blood flows through them. Cerebral: of or relating to the brain. – Clipping: A treatment to seal the aneurysm shut using a tiny metal clip that stays permanently clamped on the neck of the aneurysm. Over time, the blood vessel lining will heal along the line where the clip is placed, permanently sealing the aneurysm and preventing it growing or rupturing in the future. – Coiling: A treatment to fill an aneurysm full of tiny platinum coils so blood cannot enter it. This means the aneurysm is sealed off from the main artery, which prevents it growing or rupturing. – Occlusion: the blockage or closing of an opening or blood vessel. |
| Delayed Cerebral Ischemia and Cerebral Infarction |
| Delayed Cerebral Ischemia is “the occurrence of focal neurological impairment (such as hemiparesis, aphasia, apraxia, hemianopia, or neglect), or a decrease of at least 2 points on the Glasgow Coma Scale (either on the total score or on one of its individual components [eye, motor on either side, verbal]). This should last for at least 1 hour, is not apparent immediately after aneurysm occlusion, and cannot be attributed to other causes by means of clinical assessment, CT or MRI scanning of the brain, and appropriate laboratory studies.” Cerebral Infarction (CI) is “The presence of cerebral infarction on CT or MR scan of the brain within 6 weeks after SAH, or on the latest CT or MR scan made before death within 6 weeks, or proven at autopsy, not present on the CT or MR scan between 24 and 48 hours after early aneurysm occlusion, and not attributable to other causes such as surgical clipping or endovascular treatment. Hypodensities on CT imaging resulting from ventricular catheter or intraparenchymal hematoma should not be regarded as cerebral infarctions from DCI.” Vergouwen MDI, Vermeulen M, van Gijn J, et al. Definition of delayed cerebral ischemia after aneurysmal sub-arachnoid hemorrhage as an outcome event in clinical trials and observational studies: proposal of a multidisciplinary research group. Stroke 2010; 41: 2391–5. |
Core Outcomes in Subarachnoid Haemorrhage Research 