Discharge from the hospital

The medical-technical treatment by the neurosurgeon will gradually decrease during the time spent on the nursing ward. The focus of your admission will switch to rehabilitation.
During your recovery, you will be given advice from your treatment team about where you can recover after the hospital admission.

Discharge to home

 If you are able to perform daily tasks independently and safely, then you can be discharged to home. Your family or relatives can collect you at the agreed time. If you require further therapy at home, then you will be referred to — for example — a physical therapy or occupational therapy practice. If you require care at home, the nurse will complete an application for home nursing care. An expert from the Centrum Indicatiestelling Zorg (CIZ) [Healthcare Indication Center] will give you advice about the care that you require at home.
You may notice after some time that you continue to experience problems with fatigue, processing of stimuli, concentration or memory. This will be discussed during the follow-up appointments and if necessary you will be referred to a rehabilitation center for day treatment. 
 


  • Rehabilitation in a rehabilitation center

    For you to receive rehabilitation treatment in a rehabilitation center (Specialized Medical Rehabilitation), you must have the capacity to undergo the treatment and there must be a prospect of future discharge to the home situation. If you are selected for this form of rehabilitation, then the rehabilitation physician will enroll you. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the rehabilitation center.

    Rehabilitation in a nursing home

    If your capacity to undergo treatment is limited to such an extent that you need to rest a lot in between treatments and you do have the prospect of being discharged to the home situation in the future, then you can opt for Geriatric Rehabilitation Care (GRC) in a nursing home. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the nursing home. The Care Transfer Point will support you in selecting one of the nursing homes where GRC is possible and will arrange the registration.

    Rehabilitation for a longer period in a nursing home

    If you still require a lot of support during daily activities and it is not certain whether discharge to the home situation is an option for you, then a prolonged stay in a nursing home with rehabilitation is an option (indication 9b). You will have a longer period available in which you can work on your recovery and discharge to the home situation if possible. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the nursing home. The Care Transfer Point will support you in selecting one of the nursing homes where a stay with indication 9b is possible. 

    Early Intensive Neuro-rehabilitation (EIN)

    EIN is an intensive rehabilitation program for patients who have suffered severe brain damage and are in a state of reduced consciousness as a result. The EIN program can contribute significantly to recovering consciousness. There are only a few centers in the Netherlands where this program is available. In the southern part of the Netherlands this is available via Libranet, rehabilitation center “Het Leijpark” in Tilburg. The indication is set by the rehabilitation physicians of the institution. 

    Prolonged stay in a nursing home

    If the care staff take over most of your personal care and you are not expected to recover to such an extent that you can be discharged to the home situation, then admission for a prolonged stay is the obvious choice. Experience teaches us that this is rare in younger patients following a cerebral hemorrhage. After completing the neurosurgical treatment, you may be transferred to the peripheral hospital where you were originally admitted during the waiting time for a place in the nursing home. The Care Transfer Point will support you in selecting one of the nursing homes where a prolonged stay is possible.

home AVM-hemorrhage Subarachnoid hemorrhage
A subarachnoid hemorrhage (SAH) occurs very suddenly, without any form of warning. An AVM in the subarachnoid space can result in a SAH. You will be admitted urgently for the treatment of the consequences of the hemorrhage.
A subarachnoid hemorrhage (SAH) occurs very suddenly, without any form of warning. This hemorrhage derives its name from the location in the head: just above the brain, under the arachnoid mater. An AVM in this subarachnoid space can result in a SAH. You will be admitted urgently for the treatment of the consequences of the hemorrhage.
The blood that collects in the arachnoid mater around the brain can spread to the ventricles of the brain.
Symptoms include: acute severe headache, nausea, vomiting, neurological loss of function, stiff neck, epilepsy and reduced consciousness or loss of consciousness.

Admission to the hospital

It is vital that you receive emergency medical treatment after a subarachnoid hemorrhage and that you are taken as soon as possible to a hospital that can treat the aneurysm.

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Admission to the hospital

It is vital that you receive emergency medical treatment after a subarachnoid hemorrhage and that you are taken as soon as possible to a hospital that can treat the aneurysm. You can die or suffer severe damage as a result of this condition. The risk of a new hemorrhage is high. Once we have found the aneurysm that has caused the hemorrhage, we will try to treat the aneurysm as soon as possible. The buildup of cerebrospinal fluid can also form a life-threatening problem. In that case, a drain will be inserted in the ventricle so that the fluid can drain off. The first weeks after the hemorrhage can be unpredictable as complications regularly occur, such as blood flow problems in the brain, metabolic disruption or infections.


  • If you are admitted to the hospital, because we think that you have suffered a cerebral hemorrhage, then we will first perform a CT scan (Computer Tomography) of the brain. X-rays are used to produce a cross-section of your head. This allows us to see what type of brain hemorrhage you have had. The blood vessels can be imaged clearly in a CT scan if we inject a contrast agent via the vein in your arm (CT angiogram). This allows us to detect an AVM.
    If there is no hemorrhage visible on the CT scan, then we will perform a lumbar puncture 24 hours after the symptoms started. Cerebrospinal fluid will be collected via this lumbar puncture. We can look for signs of a subarachnoid hemorrhage in the cerebrospinal fluid.


Complications

Complications after a subarachnoid hemorrhage can be very different en are dependent on the size and the location of the bleeding. Here we explain the most common complications.

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Complications


  • The risk of a new hemorrhage is greatest in the first hours after a subarachnoid hemorrhage. If the AVM is not treated, then this risk remains elevated in the first weeks after the hemorrhage. A new hemorrhage results in acute deterioration, non-responsive or unequal pupils or reduced consciousness.


Discharge from the hospital

The medical-technical treatment by the neurosurgeon will gradually decrease during the time spent on the nursing ward. The focus of your admission will switch to rehabilitation

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Follow-up care

Each hospital in the Netherlands provides different follow-up care. Many hospitals have a special outpatient clinic for follow-up care, but this may also be arranged via a home care organization

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Scientific Research

There are a number of scientific researches at the Radboudumc in which you can partake.

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Scientific Research


  • The mRS PROM study is a study that we are performing to improve the care for people who have suffered a subarachnoid hemorrhage (SAH). We want to do this by creating a good overview of the patient’s symptoms or problems. The improvement entails asking the patient and their loved ones to complete a questionnaire before the appointment, stating what they want to discuss with the specialist.

    The study consists of three phases:

    • Phase 1: we want to study how best to organize the care after a SAH by interviewing healthcare providers and patients. For example, we want to know what symptoms patients suffered, their limitations they encounter in daily life and what affects their quality of life. In addition, we will give them a number of questionnaires, so that we can discuss whether the questions are important to them and whether the questions were asked correctly.
    • Phase 2: the questionnaire will be implemented in practice and the reliability of the questionnaire will be determined (for example, we will determine whether the questionnaire actually measures what we think it does).
    • Phase 3: we will evaluate together with the patients and healthcare providers what the benefits — or possibly the disadvantages — of completing and discussing the questionnaire are and we will evaluate whether we can make changes or improvements.