Perfectly understandable since the doctors really have no idea of what could be done to prevent another stroke.
http://www.medpagetoday.com/Cardiology/Strokes/40637?
When a patient survives a subarachnoid hemorrhage (SAH), his or her
family members and friends frequently exhibit anxiety and fear that may
become a roadblock to recovery.
In a study of 69 patients
recovering from strokes and their families, just 17.4% of the patients'
"significant others" reported having 'no fear' of a recurrent SAH,
compared with 34.3% of patients, while 21.7% of significant others
reported having 'extreme fears' of such an event, compared with 18.8% of
patients, according to Judith Covey, PhD, of Durham University in
Stockton-on-Tees, England, and colleagues.
And patients with
significant others who were most worried about recurrences tended to
have worse self-reported quality-of-life outcomes, as measured by
multi-regression analysis, they wrote in the July 23 issue of the Journal of Neurosurgery.
Using
regression modeling, the researchers examined the impact of fear of
recurrence on psychosocial outcomes in 69 patients recovering from SAH.
Subarachnoid hemorrhages most often occur as a result of a ruptured
aneurysm, arteriovenous malformation or a blow to the head, the researchers noted.
All
patients were first-time sufferers who had been admitted to one of two
British hospitals between May 2005 and August 2006; they were recruited
as part of a larger study on SAH outcomes. SAH diagnosis was confirmed
by CT scan or by the presence of blood or blood products in the
cerebrospinal fluid. Aneurysms were confirmed by CT, MRI, or catheter
angiography.
Roughly a year after the event, on average, spouses
and other close relatives and non-relatives of the patients were found
to be significantly more fearful of SAH recurrences than the patients
themselves.
Extreme fear of recurrence among the family members
and friends, but not the patients, were significant for explaining
variances in four key quality of life measures: social functioning (8.1%
variance); general health perception (7.7% variance), physical
functioning (7.4% variance) and role limitations due to emotional
problems (5.1% variance), the investigators found.
SAH survivors
and their loved ones reported similar fears that the patient would
suffer from another life-threatening health event, such as heart attack
or lung cancer. But the only domain where the patient's own fear rating
for recurrence of a brain bleed was close to significance involved
limitations due to emotional problems (4.1% variance; P=0.074).
"The
patient's fears of recurrence appeared to interfere a little with their
work and daily activities," the authors noted. "However, the
significant other's fears of recurrence interfered more -- not only
with the patient's work and daily activities, but also with their social
activities, ability to undertake moderate or vigorous physical
activities and ratings of health in general."
According to the Brain Aneurysm Foundation,
approximately 15% of patients with SAHs related to aneurysms die before
reaching the hospital and four out of seven people who recover from a
ruptured brain aneurysm will have disabilities.
But for most
people who do recover, the risk of having a second aneurysmal SAH is
very small unless the aneurysm has not been treated or has been
inadequately treated with coiling or clipping procedures, neurovascular
surgeon Roberto C. Heros, MD, of the University of Miami in Florida,
wrote in an accompanying editorial. He cited several recent studies
which all found the risk of recurrence among SAH survivors to be less
than 1% around 4 years after the rupture.
Heros noted that many
patients and their significant others believe their risk is much
greater, recounting his experience attending a monthly "aneurysm clinic"
that followed patients who had been successfully treated for an SAH.
"It
became evident to me during that initial clinic that almost all these
patients now had an 'aneurysm disease' and that they believed that they
had a chronic illness, and many of them dreaded this checkup visit for
fear that 'the aneurysm had come back'," he wrote.
Heros added
that when he told patients that their chance of recurrence was very
small, few of them believed him. "It seemed to me that after they had
the 'disease' for a few years, they couldn't trust me to offer them an
instantaneous 'cure,'" he wrote.
He got the clinic closed down and
now counsels patients about their risk of recurrence soon after their
treatment, explaining their individual risk factors.
He wrote that
considering the small risk of recurrence, neurosurgeons should not feel
obligated to recommend routine follow-up or brain imaging to patients
who have been successfully treated for a ruptured cerebral aneurysm.
"Whether
to do so or not should be an individualized decision based on a number
of factors, of which one of the most important is the possible
psychological impact on the patient and the family," he wrote.
He
added that patients with a higher risk for recurrence -- including
those whose aneurysm was incompletely clipped or coiled, those with
multiple aneurysms, a family history of aneurysms or a disease
predisposing to the formation and rupture -- should have periodic
follow-ups. But even these patients, he noted, should be counseled in a
way that reduces fears rather than reinforces them.
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