Cognitive Sequelae of Unruptured and Ruptured Intracranial Aneurysms and their Treatment: Modalities for Neuropsychological Assessment

Ghali, Michael George Zaki; Srinivasan, Visish M.; Wagner, Kathryn; Rao, Chethan Venkatasubba; Chen, Stephen R.; Johnson, Jeremiah N.; Kan, Peter

doi:10.1016/j.wneu.2018.06.178

Cited by 19 publications

(6 citation statements)

References 122 publications

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“…However, we stress that in patients with a central nervous system disease, a confounding influence of fatigue [ 86 ] and/or cognitive impairment [ 88 ] cannot conclusively be excluded. Further research is necessary to develop assessments sensitive for the specific pattern of deficits in patients with intracranial aneurysms [ 5 , 89 ]. Since statistically relevant correlations only occurred in the short term, a false-positive result has to be considered.…”

Section: Discussionmentioning

confidence: 99%

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

et al. 2020

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The vasodilatory calcitonin gene-related peptide (CGRP) is excessively released after spontaneous subarachnoid hemorrhage (sSAH) and modulates psycho-behavioral function. In this pilot study, we prospectively analyzed the treatment-specific differences in the secretion of endogenous CGRP into cerebrospinal fluid (CSF) during the acute stage after good-grade sSAH and its impact on self-reported health-related quality of life (hrQoL). Twenty-six consecutive patients (f:m = 13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out 19% (n = 5)): 35% (n = 9) underwent endovascular aneurysm occlusion, 23% (n = 6) microsurgery, and 23% (n = 6) of the patients with perimesencephalic SAH received standardized intensive medical care. An external ventricular drain was inserted within 72 h after the onset of bleeding. CSF was drawn daily from day 1–10. CGRP levels were determined via competitive enzyme immunoassay and calculated as “area under the curve” (AUC). All patients underwent a hrQoL self-report assessment (36-Item Short Form Health Survey (SF-36), ICD-10-Symptom-Rating questionnaire (ISR)) after the onset of sSAH (t1: day 11–35) and at the 6-month follow-up (t2). AUC CGRP (total mean ± SD, 5.7 ± 1.8 ng/ml/24 h) was excessively released into CSF after sSAH. AUC CGRP levels did not differ significantly when dichotomizing the aSAH (5.63 ± 1.77) and pSAH group (5.68 ± 2.08). aSAH patients revealed a higher symptom burden in the ISR supplementary item score (p = 0.021). Multiple logistic regression analyses corroborated increased mean levels of AUC CGRP in CSF at t1 as an independent prognostic factor for a significantly higher symptom burden in most ISR scores (compulsive-obsessive syndrome (OR 5.741, p = 0.018), anxiety (OR 7.748, p = 0.021), depression (OR 2.740, p = 0.005), the supplementary items (OR 2.392, p = 0.004)) and for a poorer performance in the SF-36 physical component summary score (OR 0.177, p = 0.001). In contrast, at t2, CSF AUC CGRP concentrations no longer correlated with hrQoL. To the best of our knowledge, this study is the first to correlate the levels of endogenous CSF CGRP with hrQoL outcome in good-grade sSAH patients. Excessive CGRP release into CSF may have a negative short-term impact on hrQoL and emotional health like anxiety and depression. While subacutely after sSAH, higher CSF levels of the vasodilator CGRP are supposed to be protective against vasospasm-associated cerebral ischemia, from a psychopathological point of view, our results suggest an involvement of CSF CGRP in the dysregulation of higher integrated behavior.

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Section: Discussionmentioning

confidence: 99%

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

et al. 2020

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“…Those patients could develop compensatory changes as enhanced activity in periventricular areas, which correspond to visual working tasks [12]. It is also highly important to differentiate clipping and coiling groups, given that the clipping group has been related to worse memory outcomes [13]. Remarkably, both groups are affected.…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, they reviewed some of the different assessment tools meant for evaluating cognitive function. Concerning memory, the Wechsler memory scale and Rey Osterrieth Complex Figure test were used to assess multiple domains [13].…”

Section: Memory Impairmentmentioning

confidence: 99%

Understanding Cognitive Deficit After Subarachnoid Hemorrhage: A Memory Focused Approach

Alfonso¹,

Aftab²,

Hamadneh³

et al. 2020

Cureus

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Aneurysmal subarachnoid hemorrhage (aSAH) is a prevalent condition affecting a large portion of the population, many of them still in productive ages. Memory impairment is a common factor amongst those patients. Memory exerts a pivotal role in productivity. That is why it is important to understand how it can be affected in post-aSAH patients. There are certain areas most affected in cases of memory disturbances, as well as its functional connections with crucial cerebral regions. Active research on functional magnetic resonance and diffusion tension imaging is used to identify compromised areas within the brain. There are suggested factors regarding poor performance, such as cerebrospinal fluid drainage and new infarction areas, which should be addressed properly to benefit these patients and simultaneously help them return to a productive and functional life.

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“…43 This discrepancy may bias neurocognitive outcome measures in favor of endovascular coiling. Furthermore, after a review of the literature, Zaki Ghali et al 44 noted that ACoA aneurysms had significantly better cognitive outcomes if they were treated with endovascular coiling instead of clipping. Although the mechanism remains unclear, possible contributors include intraoperative hypoxia, brain retraction, postoperative vasoconstriction, and perforator damage.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Neuropsychological Outcomes After Treatment of Intracranial Aneurysms

Nasra

Weerakkody²,

Maingard

et al. 2022

Neurosurgery

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BACKGROUND: Aneurysmal subarachnoid hemorrhage is a cause of profound morbidity and mortality. Its effects extend beyond functional neurological status to neurocognitive and psychological functioning. Endovascular treatment is becoming more prevalent after increasing evidence for its safety and efficacy; however, there is a relative paucity of evidence specific to neurocognitive status after treatment. OBJECTIVE: To assess and compare neuropsychological outcomes after the treatment of ruptured and unruptured intracranial aneurysms. METHODS: A systematic review of the literature was conducted searching for articles assessing the neuropsychological and cognitive outcomes after the treatment of ruptured and unruptured intracranial aneurysms. Inclusion criteria were English language, publication between January 2000 and October 2020, and discussion of neuropsychological outcomes in adequate detail. Outcomes were categorized into 8 domains: 5 Neurocognitive (Language, Executive Function, Complex Attention, Memory and Learning, and Perceptual motor function), Intelligence Quotient, Affect, and Quality of Life. RESULTS: Twenty-four articles were included comprising 2236 patients (924 surgical clipping, 1095 endovascular coiling, and 217 controls). These studies reported that most tests revealed no significant difference [n = 356/421 (84.56%)] between treatment modalities. More studies reported significantly superior test scores in the fields of language, executive function, and memory and learning after coiling [n = 53/421 tests (12.59%)] compared with clipping [n = 12/421 tests (2.85%)]. CONCLUSION: The current available data and published studies demonstrate a trend toward improved neurocognitive and psychological outcomes after endovascular treatment. Although these findings should be considered when deciding on the optimal treatment method for each patient, drawing definitive conclusions is difficult because of heterogeneity between patients and studies.

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Cognitive Sequelae of Unruptured and Ruptured Intracranial Aneurysms and their Treatment: Modalities for Neuropsychological Assessment

Cited by 19 publications

References 122 publications

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

Endogenous calcitonin gene-related peptide in cerebrospinal fluid and early quality of life and mental health after good-grade spontaneous subarachnoid hemorrhage—a feasibility series

Understanding Cognitive Deficit After Subarachnoid Hemorrhage: A Memory Focused Approach

A Systematic Review of Neuropsychological Outcomes After Treatment of Intracranial Aneurysms

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