Taking One Step at a Time, Uniquely, Following an Aneurysm Rupture

George Jewell, PhD, speaks during the Tri-State Brain Aneurysm Support Group’s annual symposium at the Vontz Center.

Just as no two people are alike, no two experiences with a ruptured brain aneurysm are alike. Aneurysms can differ in size, location and when they strike. “Every person’s brain is a unique and special organism,” George Jewell, PhD, explained this month at the Tri-State Brain Aneurysm Support Group’s annual symposium. “Everyone’s aneurysm is different. And everyone’s outcome is different, even though there is a shared piece that all aneurysm survivors can use to relate to one another.”

Dr. Jewell, a neuropsychologist at the UC Gardner Neuroscience Institute, Drake Center and the Lindner Center of HOPE, spoke before an audience of 140, a record for the 6-year-old event, at the Vontz Center on the UC Academic Health Center campus.

A brain aneurysm, a balloon-like bulge on a blood vessel wall, can be devastating if it becomes stretched so thin that it ruptures. Approximately 27,000 Americans suffer such a rupture each year, and up to 50 percent of those who survive can face significant cognitive changes. Cognition involves memory, reasoning, communicating and the performance of executive tasks, such as planning and decision-making.

Recovery can be relative, Dr. Jewell noted. “Sometimes there are really good physical outcomes. An individual will be walking and talking just fine; but there may still be cognitive changes.”

The good news, he said, is that cognitive improvements following an aneurysm rupture continue for a longer period than previously thought.

“We know that in general there is significant recovery after a ruptured aneurysm,” Dr. Jewell said. “In the early days we believed that cognitive recovery occurred quickly and was complete after the first few months. Over time, however, we have learned that the recovery curve is a lot longer than we believed. Even though significant recovery occurs in the first few months, it does continue – although at a slower pace – throughout the first year.”

The larger the rupture, he added, the longer the recovery will be and the longer the timeframe until the individual reaches a cognitive plateau.

Memory

The most common complaint among survivors involves short-term memory, as memories that have not yet been consolidated into long-term memory may not be recalled, or retrieved. Survivors often have a zone of time, dating from the time of the hemorrhage, which is unlikely to be recalled, Dr. Jewell said.

Long-term memory, on the other hand, is less likely to be affected.

“Anything autobiographical is very well protected and resistant and is unlikely to be altered by a brain aneurysm or brain injury or disease,” Dr. Jewell said. “This contrasts with what you may see in the movies, which portray people who, after some traumatic event, don’t remember who they are.”

Cognitive challenges appear in other forms as well. Survivors can have difficulty concentrating, focusing, or processing visual information accurately or quickly, and they can struggle to perform executive functions, such as problem-solving, that were once routine. Patients who have suffered an aneurysm rupture at the anterior communicating artery, which connects the two anterior cerebral arteries and is one of the most common sites of brain aneurysms, have more problems with memory and executive function than survivors whose aneurysm was located elsewhere. Emotional and personality changes can compound the adjustment, causing survivors to experience anxiety, depression, frustration, anger, irritability and lack of motivation. Medication can help, Dr. Jewell said, and studies suggest that the first medication tried for depression will be successful approximately two-thirds of the time.

Dr. Jewell offered the following tips for survivors:

  • Find a hobby and embrace your life
  • Carry a datebook with you
  • Keep a calendar, notepad and pencil near your main telephone
  • Always put important items, such as keys, in the same place
  • Make eye contact with someone who is speaking to you, as this will help you encode what is being said and remember it later
  • Don’t be shy about asking someone to repeat what he or she said

As a neuropsychologist, Dr. Jewell helps survivors and family members determine whether an individual has returned to a defined cognitive level.

“You should generally wait around three months after an aneurysm rupture before having neuropsychological testing unless there is a reason why you need to know sooner,” he said. “It also works best if you have a clear goal about what you want to know. Does the individual want to return to work? Does he or she want to start driving again?”

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For more information about the Tri-State Brain Aneurysm Support Group, please call (513) 475-8636 or visit http://www.tsbaconnex.org/

The Tri-State Brain Aneurysm Support Group, one of the first of its kind nationally, was founded in 2002 by Mario Zuccarello, MD, Mayfield Clinic neurosurgeon and Chairman of UC’s Department of Neurosurgery; Laura Sauerbeck, RN, a researcher in UC’s Department of Neurology; and survivor Sandy Ross. The organization meets regularly and engages expert speakers in its quest to help survivors grow and connect with each other throughout their recovery and after.

— Cindy Starr

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