Skip to main content

Advertisement

SpringerLink
Log in

Hippocampal damage and affective disorders after treatment of cerebral aneurysms

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

Despite good neurological outcome after the treatment of ruptured or incidental cerebral aneurysms, many patients complain about mood disturbances such as anxiety and depression. The present study investigated the nature of these affective disorders, their trigger factors, and corresponding structural brain changes. We assessed 63 patients matched by history of previous subarachnoid hemorrhage (SAH) and treatment modality (clipping vs. coiling) by a test battery including the Hospital Anxiety and Depression Scale (HADS) and beck depression inventory-II (BDI-II). MR imaging for the evaluation of structural changes included H1-MR spectroscopy, hippocampal volumetry, and diffusion tensor imaging (DTI). The applied multimodal imaging revealed no significant differences between patients with previous SAH and patients with incidental aneurysms; there were also no substantial differences between patients with and without previous SAH with respect to depression and anxiety. However, we observed significantly higher mean HADS scores in patients treated surgically versus patients treated by coiling (p < 0.01). BDI-II tended to be higher in surgically treated patients, but this difference appeared statistically insignificant. Surgically treated patients displayed substantial hippocampal damage in all imaging techniques: reduction in mean concentrations of N-acetylaspartate (p = 0.04), hippocampal volume reduction (p = 0.012), and diffusion disorder (p = 0.02). The structural alterations correlated significantly with the increased HADS scores. In contrast to endovascular treatment, aneurysm surgery seems to be associated with an increased incidence of mood disorders corresponding to hippocampal neuronal loss, independent of preceding SAH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Hop JW, Rinkel GJ, Algra A, van Gijn J (1997) Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke 28:660–664 (a journal of cerebral circulation)

    Article  CAS  PubMed  Google Scholar 

  2. Al-Khindi T, Macdonald RL, Schweizer TA (2010) Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 41:e519–e536 (a journal of cerebral circulation)

    Article  PubMed  Google Scholar 

  3. Beck ATSR, Brown GK (1996) Beck Depression Inventory. San Antonio, The Psychological Corp

    Google Scholar 

  4. Stienen MN, Weisshaupt R, Fandino J, Fung C, Keller E, Hildebrandt G, Studerus-Germann A, Muri R, Gutbrod K, Blasi S, Monsch AU, Brugger P, Mondadori C, Sailer M, Bijlenga P, Schaller K, Schatlo B, on behalf of the Swiss SOSsg (2013) Current practice in neuropsychological outcome reporting after aneurysmal subarachnoid haemorrhage. Acta neurochirurgica

  5. Bendel P, Koivisto T, Hanninen T, Kolehmainen A, Kononen M, Hurskainen H, Pennanen C, Vanninen R (2006) Subarachnoid hemorrhage is followed by temporomesial volume loss: MRI volumetric study. Neurology 67:575–582

    Article  CAS  PubMed  Google Scholar 

  6. Proust F, Martinaud O, Gerardin E, Derrey S, Leveque S, Bioux S, Tollard E, Clavier E, Langlois O, Godefroy O, Hannequin D, Freger P (2009) Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. J Neurosurg 110:19–29

    Article  PubMed  Google Scholar 

  7. Maller JJ, Thomson RH, Lewis PM, Rose SE, Pannek K, Fitzgerald PB (2010) Traumatic brain injury, major depression, and diffusion tensor imaging: making connections. Brain Res Rev 64:213–240

    Article  PubMed  Google Scholar 

  8. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  PubMed  Google Scholar 

  9. Schuff N, Neylan TC, Fox-Bosetti S, Lenoci M, Samuelson KW, Studholme C, Kornak J, Marmar CR, Weiner MW (2008) Abnormal N-acetylaspartate in hippocampus and anterior cingulate in posttraumatic stress disorder. Psychiatry Res 162:147–157

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Sapolsky RM (2000) Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders. Arch Gen Psychiatry 57:925–935

    Article  CAS  PubMed  Google Scholar 

  11. Raps EC, Rogers JD, Galetta SL, Solomon RA, Lennihan L, Klebanoff LM, Fink ME (1993) The clinical spectrum of unruptured intracranial aneurysms. Arch Neurol 50:265–268

    Article  CAS  PubMed  Google Scholar 

  12. Bendel P, Koivisto T, Niskanen E, Kononen M, Aikia M, Hanninen T, Koskenkorva P, Vanninen R (2009) Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study. Neuroradiology 51:711–722

    Article  PubMed  Google Scholar 

  13. Wang SH, Zhang ZJ, Guo YJ, Teng GJ, Chen BA (2009) Decreased expression of serotonin 1A receptor in the dentate gyrus in association with chronic mild stress: a rat model of post-stroke depression. Psychiatry Res 170:245–251

    Article  CAS  PubMed  Google Scholar 

  14. Kreitschmann-Andermahr I, Poll E, Hutter BO, Reineke A, Kristes S, Gilsbach JM, Saller B (2007) Quality of life and psychiatric sequelae following aneurysmal subarachnoid haemorrhage: does neuroendocrine dysfunction play a role? Clin Endocrinol 66:833–837

    Article  Google Scholar 

  15. von Lehe MM K, Fimmers R, Clusmann H (2011) Comparison of quality of life (QOL) after epilepsy surgery and after clipping of incidental aneurysms. In: 62nd Annual Meeting of the German Society of Neurosurgery (DGNC). Hamburg, Germany

  16. Hadjivassiliou M, Tooth CL, Romanowski CA, Byrne J, Battersby RD, Oxbury S, Crewswell CS, Burkitt E, Stokes NA, Paul C, Mayes AR, Sagar HJ (2001) Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling. Neurology 56:1672–1677

    Article  CAS  PubMed  Google Scholar 

  17. Peng HJ, Zheng HR, Ning YP, Zhang Y, Shan BC, Zhang L, Yang HC, Liu J, Li ZX, Zhou JS, Zhang ZJ, Li LJ (2013) Abnormalities of cortical-limbic-cerebellar white matter networks may contribute to treatment-resistant depression: a diffusion tensor imaging study. BMC Psychiatry 13:72

    Article  PubMed Central  PubMed  Google Scholar 

  18. Brilstra EH, Rinkel GJ, van der Graaf Y, Sluzewski M, Groen RJ, Lo RT, Tulleken CA (2004) Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study. Cerebrovas Dis 17:44–52

    Article  Google Scholar 

  19. Latimer SF, Wilson FC, McCusker CG, Caldwell SB, Rennie I (2013) Subarachnoid haemorrhage (SAH): long-term cognitive outcome in patients treated with surgical clipping or endovascular coiling. Disabil Rehabil 35:845–850

    Article  PubMed  Google Scholar 

  20. Aben I, Verhey F, Lousberg R, Lodder J, Honig A (2002) Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and hamilton depression rating scale as screening instruments for depression in stroke patients. Psychosomatics 43:386–393

    Article  PubMed  Google Scholar 

  21. Glodzik-Sobanska L, Slowik A, McHugh P, Sobiecka B, Kozub J, Rich KE, Urbanik A, Szczudlik A (2006) Single voxel proton magnetic resonance spectroscopy in post-stroke depression. Psychiatry Res 148:111–120

    Article  PubMed  Google Scholar 

  22. Provencher SW (1993) Estimation of metabolite concentrations from localized in vivo proton NMR spectra. Magnetic Reson Med 30:672–679 (official journal of the Society of Magnetic Resonance in Medicine/Society of Magnetic Resonance in Medicine)

    Article  CAS  Google Scholar 

  23. Fang J, Cheng Q (2009) Etiological mechanisms of post-stroke depression: a review. Neurol Res 31:904–909

    Article  PubMed  Google Scholar 

  24. Frazer D, Ahuja A, Watkins L, Cipolotti L (2007) Coiling versus clipping for the treatment of aneurysmal subarachnoid hemorrhage: a longitudinal investigation into cognitive outcome. Neurosurgery 60:434–441 (discussion 441–432)

    Article  PubMed  Google Scholar 

  25. Gabaldon L, Fuentes B, Frank-Garcia A, Diez-Tejedor E (2007) Poststroke depression: importance of its detection and treatment. Cerebrovasc Dis 24(Suppl 1):181–188

    PubMed  Google Scholar 

  26. Paolucci S (2008) Epidemiology and treatment of post-stroke depression. Neuropsyc Dis Treat 4:145–154

    Article  Google Scholar 

  27. Hutter BO, Gilsbach JM, Kreitschmann I (1995) Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg 9:465–475

    Article  CAS  PubMed  Google Scholar 

  28. Orbo M, Waterloo K, Egge A, Isaksen J, Ingebrigtsen T, Romner B (2008) Predictors for cognitive impairment one year after surgery for aneurysmal subarachnoid hemorrhage. J Neurol 255:1770–1776

    Article  CAS  PubMed  Google Scholar 

  29. Chen MC, Hamilton JP, Gotlib IH (2010) Decreased hippocampal volume in healthy girls at risk of depression. Arch Gen Psychiatry 67:270–276

    Article  PubMed Central  PubMed  Google Scholar 

  30. Powell J, Kitchen N, Heslin J, Greenwood R (2002) Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis. J Neurol Neurosurg Psychiatry 72:772–781

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Hackett ML, Anderson CS (2000) Health outcomes 1 year after subarachnoid hemorrhage: an international population-based study. The Australian Cooperative Research on Subarachnoid Hemorrhage Study Group. Neurology 55:658–662

    Article  CAS  PubMed  Google Scholar 

  32. Hedlund M, Zetterling M, Ronne-Engstrom E, Carlsson M, Ekselius L (2011) Depression and post-traumatic stress disorder after aneurysmal subarachnoid haemorrhage in relation to lifetime psychiatric morbidity. Br J Neurosurg 25:693–700

    Article  PubMed Central  PubMed  Google Scholar 

  33. Kreiter KT, Rosengart AJ, Claassen J, Fitzsimmons BF, Peery S, Du YE, Connolly ES, Mayer SA (2013) Depressed mood and quality of life after subarachnoid hemorrhage. J Neurol Sci 335:64–71

    Article  PubMed  Google Scholar 

  34. Morris PG, Wilson JT, Dunn L (2004) Anxiety and depression after spontaneous subarachnoid hemorrhage. Neurosurgery 54:47–52 (discussion 52–44)

    Article  PubMed  Google Scholar 

  35. Sims A, Sims D (1998) The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma. Psychopathology 31:96–112

    Article  CAS  PubMed  Google Scholar 

  36. Bremner JD, Narayan M, Anderson ER, Staib LH, Miller HL, Charney DS (2000) Hippocampal volume reduction in major depression. Am J Psychiatry 157:115–118

    Article  CAS  PubMed  Google Scholar 

  37. Ebisu T, Rooney WD, Graham SH, Weiner MW, Maudsley AA (1994) N-acetylaspartate as an in vivo marker of neuronal viability in kainate-induced status epilepticus: 1H magnetic resonance spectroscopic imaging. J Cereb Blood Flow Metab 14:373–382 (official journal of the International Society of Cerebral Blood Flow and Metabolism)

    Article  CAS  PubMed  Google Scholar 

Download references

Conflicts of interests

The authors declare that they have no conflict of interest.

Ethical standard

The present study received approval from the ethics commitee of the Technical University of Munich and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. All patients gave appropriate informed consent.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Maria Wostrack, Benjamin Friedrich, Katrin Hammer, Kathrin Harmening, Florian Ringel, Ehab Shiban, Bernhard Meyer & Yu-Mi Ryang

  2. Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

    Benjamin Friedrich, Tobias Boeckh-Behrens, Sascha Prothmann, Claus Zimmer & Annette Förschler

  3. Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany

    Benjamin Friedrich

  4. Department of Neurology, Working Group for Clinical and Experimental Neuropsychology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany

    Anne Stankewitz

  5. Department of Clinical and Interventional Neuroradiology, Vivantes Klinik Neukoelln, Berlin, Germany

    Annette Förschler

Authors
  1. Maria Wostrack
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Benjamin Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Katrin Hammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kathrin Harmening
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Anne Stankewitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Florian Ringel
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ehab Shiban
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tobias Boeckh-Behrens
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sascha Prothmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Claus Zimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bernhard Meyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Annette Förschler
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yu-Mi Ryang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maria Wostrack.

Additional information

Maria Wostrack and Benjamin Friedrich contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wostrack, M., Friedrich, B., Hammer, K. et al. Hippocampal damage and affective disorders after treatment of cerebral aneurysms. J Neurol 261, 2128–2135 (2014). https://doi.org/10.1007/s00415-014-7464-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-014-7464-y

Keywords

Search

Navigation