Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery.

Aneurysmal subarachnoid hemorrhage leaves around 50% of the patients permanently disabled (1), with the same percentage unable ever to return to the same level of work they had had before the event (2). Cognitive dysfunction, a common consequence of aneurysmal subarachnoid hemorrhage (3), is present to various degrees even in patients with good outcomes and without neurological deficits (4), causing considerable distress not only to the patients themselves, but also to their families. The persistence of cognitive dysfunction can have a profound influence on the rehabilitation process and social and occupational reintegration of the patients. Patients may experience deficits in executive functions, memory, psychomotor speed, attention, visuospatial abilities, and other cognitive domains (3,5-7). The typical pattern is thought to be mild-to-moderate dysfunction across multiple cognitive domains (8,9), although some studies have confirmed only severe impairment in a subset of patients rather than mild-to-moderate impairment in most of them (3). Reports on different patterns of cognitive deficit, depending on the site of the aneurysm, are inconsistent (3,10). Different patterns may be present in patients with aneurysmal subarachnoid hemorrhage in identical locations (11). Earlier studies that explored cognitive deficits after subarachnoid hemorrhage from the anterior communicating artery (ACoA) described a special “ACoA syndrome”, characterized by amnesia, personality changes, and confabulation as the main symptoms (12-16), where damage to particular anterior cerebral structures was a suspected cause (14,15,17). However, other studies did not find specific deficits in ACoA patients, and a more diffuse pattern of brain damage was thought to be responsible for the deficits (9,18,19). Accurate cognitive assessment of patients after aneurysmal subarachnoid hemorrhage could improve treatment measures in the preoperative and postoperative periods and help in accurate guidance of rehabilitation. Previous studies have not simultaneously addressed patients’ and relatives’ views of cognitive deficits, their level of community integration, and the results of neuropsychological and neurophysiological tests. In this study, we explored long-term cognitive deficits in a small, selected group of patients with good outcome after subarachnoid hemorrhage due to the rupture of the anterior communicating artery aneurysm. Our aim was to determine whether long-term changes in brain functioning could be detected with a simple and objective method that could be of potential use at different time points after subarachnoid hemorrhage, and to determine if diminished cognitive capacities seen on neuropsychological test results were also reflected in neurophysiological measurements, since this could also provide some information regarding localization and the degree of brain damage.