Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery.
OBJECTIVE
To evaluate long-term cognitive consequences of subarachnoid hemorrhage with good outcome and the opinion of patients and their relatives about these consequences.


METHODS
The study included 10 patients surgically treated for subarachnoid hemorrhage due to the rupture of aneurysm of the anterior communicating artery 2 or more years earlier, and 10 age- and sex-matched healthy controls. The preoperative and postoperative course in the patients was uneventful. Clinical and psychosocial factors and cognitive status of the patients were assessed by use of checklists and neuropsychological tests for executive functions, attention, and memory, and event-related potential recordings (waves P3a and P3b) with tree-stimulus auditory oddball paradigm, which was also performed in healthy controls.


RESULTS
The number of reported cognitive problems negatively correlated with the patients' level of community integration (rho range, -0.22 to -0.75). The average neuropsychological results ranged between the 12th and 46th percentile. Impaired results were found in 7 patients across different tests and were most frequent for visual memory, followed by verbal memory and executive functions. A clear decline in cognitive functioning was observed in 3 patients. Neither P3a nor P3b wave could be found in 3 patients. In comparison with controls, patients had significantly longer P3b wave latencies (364 vs 334 ms; Mann-Whitney U test, P = 0.025). We found statistically non-significant, but still prominent negative correlations between the sustained attention results and latencies of P3a (rho = -0.58; P = 0.172) and P3b (rho = -0.58; P = 0.172) waves.


CONCLUSIONS
Despite good outcome after subarachnoid hemorrhage, persistent cognitive consequences were still manifest, limiting the patients' psychosocial functioning. The correlation between neuropsychological and neurophysiological measures indicated frontal lobe damage, which in some patients persisted for years after the hemorrhage.
Ravnik
Janez
J
Department of Neurosurgery, General Hospital Maribor, Maribor, Slovenia. jravnik@planet.si
Starovasnik
Barbara
B
Sesok
Sanja
S
Pirtosek
Zvezdan
Z
Svigelj
Viktor
V
Bunc
Gorazd
G
Bosnjak
Roman
R
D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D016896:Treatment Outcome