Independent living following a ‘Do Not Resuscitate’ order after subarachnoid haemorrhage

Abstract

Purpose. The recovery and psychosocial adjustment of a 41-year-old right handed women (K.E.) following subarachnoid haemorrhage (SAH) with initially poor predicted prognosis is presented.

Method. A single case report with an early post surgery ‘Do Not Resuscitate’ order following SAH with a significant period of impaired consciousness is outlined.

Results. Following a right frontal craniotomy and clipping of a left distal anterior communicating artery (AcoA) aneurysm, K.E. was unresponsive for 23 days and ‘minimally conscious’ for a further 5+ weeks post surgery (36 days). At two months post insult, after some neurological improvement, she was transferred for post-acute goal directed neurorehabilitation. At 8 months post insult, after 4 months inpatient and 2 months intensive outpatient neurorehabilitation, K.E. was largely independent, did not require home care services and had made a good psychosocial adjustment to her acquired difficulties.

Conclusions. The potential for recovery following a significant period of reduced consciousness after SAH is highlighted despite initially poor prognostic indicators.

Keywords:

• Subarachnoid haemorrhage
• recovery
• minimally conscious state (MCS)
• cognitive outcome