Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study.
BACKGROUND
Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is frequently detected. Here, we describe the pattern of cerebral (gray matter) atrophy and its clinical relevance after treatment of aSAH caused by a ruptured anterior cerebral artery (ACA) aneurysm.


METHODS
Thirty-seven aSAH patients with ACA aneurysm (17 surgical, 20 endovascular treatment) and a good or moderate clinical outcome (Glasgow Outcome Scale V or IV) and 30 controls underwent brain MRI. Voxel-based morphometric analysis was applied to compare the patients and controls. Patients also underwent a detailed neuropsychological assessment.


RESULTS
The comparisons between controls and either all patients (n = 37) or the subgroup of surgically treated patients (n = 17) revealed bilateral cortical atrophy in the frontal lobes, mainly in the basal areas. The brainstem, bilateral thalamic and hypothalamic areas, and ipsilateral caudate nucleus were also involved. Small areas of atrophy were detected in temporal lobes. The hippocampus and parahippocampal gyrus showed atrophy ipsilateral to the surgical approach. In the subgroup of endovascularly treated patients (n = 15), small areas of atrophy were detected in the bilateral orbitofrontal cortex and in the thalamic region. Twenty patients (54%) showed cognitive deficits in neuropsychological assessment.


CONCLUSIONS
Group analysis after aSAH and treatment of the ruptured ACA aneurysm revealed gray matter atrophy, principally involving the frontobasal cortical areas and hippocampus ipsilateral to the surgical approach. Areas of reduced gray matter were more pronounced after surgical than endovascular treatment. Together with possible focal cortical infarctions and brain retraction deficits in individual patients, this finding may explain the neuropsychological disturbances commonly detected after treatment of ruptured ACA aneurysms.
Bendel
Paula
P
Department of Clinical Radiology, Kuopio University Hospital and University of Kuopio, Puijonlaaksontie 2, 70210 Kuopio, Finland. paula.bendel@kuh.fi
Koivisto
Timo
T
Niskanen
Eini
E
Könönen
Mervi
M
Aikiä
Marja
M
Hänninen
Tuomo
T
Koskenkorva
Päivi
P
Vanninen
Ritva
R
D000208:Acute Disease; D001284:Atrophy; D001921:Brain / Q000473:pathology* / Q000601:surgery; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002532:Intracranial Aneurysm / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D036421:Nerve Fibers, Unmyelinated / Q000473:pathology; D009483:Neuropsychological Tests; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D016896:Treatment Outcome