Cerebral aneurysms and arteriovenous malformations: implications for rehabilitation

Arteriovenous malformations (AVM) and intracranial aneurysms often have devastating impact when they present as subarachnoid hemorrhage (SAH). With an overall incidence of 10 to 16 per 100,000, subarachnoid hemorrhage is relatively rare; however, these patients often comprise a significant component of a rehabilitation specialist's practice. There exists a host of risk factors and premorbid characteristics that correlate with long-term outcome after aneurysmal and AVM-related subarachnoid hemorrhage. Physical, cognitive, behavioral, and social deficits are relatively common after SAH, and can have a significant impact on effective home, community, and work reentry. Seizure risk after SAH or craniotomy and the use of prophylactic anticonvulsant medications is often a confusing and troublesome issue for the rehabilitation specialist. This situation often is handled by weighing the potential risk of serious medication side effects against the potential seizure risk. Cognitive, behavioral, and social sequelae are most frequent in patients with anterior cerebral and communicating artery lesions; however, delayed ischemic dysfunction often accounts for these deficits in patients with lesions in other distributions. An understanding of the classification, incidence, presentation, complications and treatment of arteriovenous malformations and intracranial aneurysms is especially important for the rehabilitation specialist. Knowledge about these areas assists the rehabilitation specialist in developing an individual rehabilitation plan that sets realistic goals for predicted outcomes. In addition, such knowledge enhances appropriate monitoring of patient progress, so that early interventions can be established when there is an alteration in clinical status.