Neuropsychological course after surgery for intracranial aneurysms. A prospective study and a critical review

Abstract

Previously, only three studies with representative samples of patients with ruptured intracranial aneurysms have provided detailed results of prospective, repeated, neuropsychological assessments after surgery. These studies apparently disagree with regard to occurrence of cognitive deficits and to degree of improvement between early and delayed follow-ups. The present paper attempts to analyze the conditions underlying these differences in results. As a first step in this analysis we present a comprehensive, prospective, neuropsychological investigation of a consecutive sample of 41 patients with rupture of a supratentorial aneurysm, assessed 4 and 12 months after surgery. It is concluded that a prorated course of improvement of a wide specter of psychological functions may be revealed, but that sensitive tests and large samples are needed to establish the range of deficits and improvements with time. Differences in patient selection with respect to severity of the acute clinical state and delayed deterioration apparently contribute importantly to the discrepance in previously reported outcome.

Predictors of Cognitive Dysfunction After Subarachnoid Hemorrhage

“…Perhaps the most important is that our follow-up period was only 3 months, and many participants were probably still in the active phase of recovery. 5,9 Analysis after a longer period of follow-up is needed to determine whether the cognitive deficits we identified persisted in the long term; this will be the subject of a future report. Second, although one study found that a large proportion of SAH patients suffer from role limitations related to physical problems, 37 it is unclear to what extent cognitive dysfunction after SAH affects health-related quality of life.…”

“…Many investigators have evaluated the effect of aneurysm location on cognitive function after SAH, 5,7-9,23,24,26,28,32,34 -36 but few have reported significant associations; aneurysms of the anterior communicating artery, 34 vertebrobasilar system, 8 and left anterior circulation 9 have previously been associated with poor cognitive outcome. In our study, posterior circulation aneurysms were associated with better performance in 7 of 8 domains in the univariate analyses and in both memory domains in the multivariate analysis.…”

“…In the prevailing view, the typical pattern of mild-to-moderate dysfunction across multiple cognitive domains has been See Editorial Comment, page 208 thought to reflect diffuse injury caused by ictal intracranial circulatory arrest 5,6 and exposure of the brain to subarachnoid blood. 2 Other studies of cognitive outcome after SAH have identified intracerebral and intraventricular hemorrhage (ICH and IVH), 5 hydrocephalus, 5 delayed cerebral ischemia (DCI) or infarction, 5,7,8 and aneurysm location 8,9 as risk factors for domain-specific cognitive dysfunction. 3 The relative importance of these different types of injury is unknown, however, and other possible mechanisms of injury, such as cerebral edema, remain unexplored.…”

Increased Frontal Lobe Activation After Aneurysmal Subarachnoid Hemorrhage

“…7,10,26 The influence of other factors such as hydrocephalus, aneurysm location, treatment method, vasospasm, and ischemic complications on neurocognitive sequelae are less clear. 10,12,16,28 These pathological processes are acute or subacute issues and would not be expected to lead to permanent deficits in the absence of ischemic damage to the neural tissue. However, evidence that physiopathological changes in the acute phase of aSAH do not lead to permanent functional neuronal change is unavailable.…”

Long-Term Results of the Microsurgical Treatment of the Cerebral Aneurysm Ruptures in Patients at a Compensated State

“…Ана-лиз ближайших функциональных исходов свиде-тельствует о наличии когнитивных расстройств разной степени выраженности у 59% больных на момент выписки из стационара [4]. 60-70% больных, состояние которых до операции было 1-3 балла по шкале Hunt-Hess, в послеопераци-онном периоде не имеют тяжелых когнитивных расстройств, нарушавших психосоциальную адаптацию [5]. В восстановительном периоде заболевания когнитивные расстройства име-ют 65% пациентов [6].…”