CEREBRAL ANEURYSMS AND ARTERIOVENOUS-MALFORMATIONS - IMPLICATIONS FORREHABILITATION

Arteriovenous malformations (AVM) and intracranial aneurysms often hav e devastating impact when they present as subarachnoid hemorrhage (SAH ). With an overall incidence of 10 to 16 per 100,000, subarachnoid hem orrhage is relatively rare; however, these patients often comprise a s ignificant component of a rehabilitation specialist's practice. There exists a host of risk factors and premorbid characteristics that corre late with longterm outcome after aneurysmal and AVM-related subarachno id hemorrhage. Physical, cognitive, behavioral, and social deficits ar e relatively common after SAH, and can have a significant impact on ef fective home, community, and work reentry. Seizure risk after SAH or c raniotomy and the use of prophylactic anticonvulsant medications is of ten a confusing and troublesome issue for the rehabilitation specialis t. This situation often is handled by weighing the potential risk of s erious medication side effects against the potential seizure risk. Cog nitive, behavioral, and social sequelae are most frequent in patients with anterior cerebral and communicating artery lesions; however, dela yed ischemic dysfunction often accounts for these deficits in patients with lesions in other distributions. An understanding of the classifi cation, incidence, presentation, complications and treatment of arteri ovenous malformations and intracranial aneurysms is especially importa nt for the rehabilitation specialist. Knowledge about these areas assi sts the rehabilitation specialist in developing an individual rehabili tation plan that sets realistic goals for predicted outcomes. In addit ion, such knowledge enhances appropriate monitoring of patient progres s, so that early interventions can be established when there is an alt eration in clinical status.