Neurobehavioural disturbances, rehabilitation outcome, and lesion site in patients after rupture and repair of anterior communicating artery aneurysm

Abstract

Objective-To determine: (1) patterns of cognitive and psychiatric dysfunction; (2) those neurobehavioural parameters which mostly influence disability in activities of daily living (ADL) and handicap in occupational and psychosocial activities, and (3) underlying neuroanatomical pathology in patients after rupture and repair of anterior communicating artery (ACoA) aneurysm. Methods-30 patients were extensively examined by means of a comprehensive battery of neuropsychological tests, by rating of psychopathological symptoms, and by use of the functional independence measure (FIM), Glasgow outcome scale (GOS), and MRI. Results and conclusions-(1) Three main groups were characterised by primary impairment of memory, executive functions, or of attentional performance. Within these main groups, specific patterns were identified relating to extent of primary dysfunction and associated disorders. The variety of neuropsychological disturbances is in contradiction to the existence of an "ACoA syndrome" as an entity. (2) Rehabilitation outcome proved to be mostly associated with both memory and attentional performance. (3) In neuropathological terms, lesions of the medial septum and nucleus of the diagonal band of Broca (MS/ndbB) were closely associated with memory deficits and prefrontal lesions were associated with attentional, executive, and psychopathological dysfunctions. At the same time, bilateral lesions were associated with severe disturbances. The type and severity of the above mentioned deficits were independent of the side of lesion in unilateral cases, of rectus gyrus resection, and of the Hunt and Hess grading system. (J Neurol Neurosurg Psychiatry 1998;65:93-102)

MR Imaging of Subcallosal Artery Infarct Causing Amnesia after Surgery for Anterior Communicating Artery Aneurysm

“…25 Several neuropsychological studies, however, indicated that the lesions in the orbitofrontal area alone did not cause amnesia. 3,36,37 Alternatively, several reports attributed basal forebrain amnesia to interruption of the cholinergic system. 1,3,11,38 Indeed, in our patients, infarction in the paraterminal gyrus in 8 and in the diagonal band of Broca in 5 suggests likely involvement of the cholinergic system.…”

Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment

“…Moreover, gyrus rectus resection caused focal encephalomalacia, but no consequences on the diverse neuropsychological evaluation were observed. In the literature, partial subpial resection of the gyrus rec tus during the pterional approach 53 to the ACoA aneurysm has not been reported to cause any adverse effects on neu robehavioral variables 5 or on QOL. 31 The choice of the side of approach did not cause any significant cognitive conse quences.…”

“…5 In addition to the consequences of SAH in the subfrontal area, authors of some prospective studies (with level 3 evidence) have attempted to investigate the involvement of sac exclusion regarding outcome. It seems that the cog nitive outcome of patients treated by endovascular coiling was more favorable than that in those treated by micro surgical clipping.…”

“…However, most of these studies did not take aneurysm location into con sideration, 9,11,25,26,30,37,40,44,45,47,52 or rarely did they focus on the ACoA. 4,5,10,18,19 For this location, essentially verbal memory, executive functions, and QOL are affected.…”

Recovery of Cognitive Function After Surgery for Aneurysmal Subarachnoid Hemorrhage

“…5 Controversy exists regarding the impact of anatomical location of the aneurysm on cognitive function after SAH. Early studies 21,[25][26][27] suggested patients with anterior communicating artery aneurysms are particularly susceptible to amnesia although recent reports 23,24,[27][28][29][30][31] failed to find a difference related to aneurysm location. Lack of standardized time of follow-up and small numbers of patients in some investigations potentially contributed to the differences.…”