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Neuropsychological assessments in patients with aneurysmal subarachnoid hemorrhage, perimesencephalic SAH, and incidental aneurysms

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Abstract

Subarachnoid hemorrhage (SAH) is known to be associated with long-term cognitive deficits. Neurosurgical manipulation on the brain itself has been reported to have influence on neuropsychological sequelae. The following is a comparative study on perimesencephalic and aneurysmal subarachnoid hemorrhage patients as well as elective aneurysm patients that was carried out to determine the isolated and combined impact of surgical manipulation and hemorrhage, respectively, on long-term neuropsychological outcome. Inclusion criteria were good neurological recovery at discharge (modified Rankin Scale 0 or 1) without focal neurological deficit. Standardized psychological testing covered attention, memory, executive functions, and mood. Thirteen aneurysmal SAH patients, 15 patients undergoing elective clipping, and 14 patients with perimesencephalic SAH were analyzed. Standardized neuropsychological testing and social/professional history questionnaires were performed 2 years (mean) after discharge. Memory impairment and slower cognitive processing were found in the aneurysmal and perimesencephalic SAH groups, while elective aneurysm patients showed signs of impaired attention. However, compared with norm data for age-matched healthy controls, all groups showed no significant test results. In contrast, signs of clinical depression were seen in 9/42 patients, 45 % of all patients complained of stress disorders and 55 % of patients were unable to work in their previous professions. Nearly normal neuropsychological test results on long-term follow-up in SAH patients were unexpected. However, a 50 % rate of unemployment accompanied with stress disorders and depression manifests insufficient social and workplace reintegration. Therefore, even more specific rehabilitation programs are required following inpatient treatment to attain full recovery.

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Acknowledgments

We would like to thank the psychological department of the University of Hamburg for technical support and C. Wein and P. Pawlik personally for their advice in choosing psychological tests.

Conflict of interest

The authors have no conflicts of interest or financial affiliations to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Kara Krajewski, Tobias Martens, Johannes Köppen, Manfred Westphal & Jan Regelsberger

  2. Department of Neuropsychology, Wilhelmsburger Krankenhaus Groß-Sand, Groß-Sand 3, 21107, Hamburg, Germany

    Susanne Dombek

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  1. Kara Krajewski
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  2. Susanne Dombek
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  3. Tobias Martens
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Correspondence to Kara Krajewski.

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Comments

Takashi Sadatomo, Hiroshima, Japan

The author clarified in this article that 55 % of the patients who underwent aneurismal clipping or suffered from perimesencephalic SAH lost their previous work, and the unemployment rates among each group (A, B, and C) did not show differences (A = 7/13, B = 8/15, C = 8/14). And, these patients did not show focal neurological deficits and significant cognitive deficits. So the author mentions that diagnostic awareness for minor cognitive complaints and depressive episode must be heightened and professional help must took effect and then informing the patients these possible problems is necessary.

These results from this article seem to contain important information although the number of the patients is small for now. As a next step, it would be hopeful that the author will also disclose which lines of profession are difficult or relatively easy to regain for the patients.

These information would be imperative especially for the cases of unruptured aneurysms when they were confirmed in a large scale.

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Krajewski, K., Dombek, S., Martens, T. et al. Neuropsychological assessments in patients with aneurysmal subarachnoid hemorrhage, perimesencephalic SAH, and incidental aneurysms. Neurosurg Rev 37, 55–62 (2014). https://doi.org/10.1007/s10143-013-0489-3

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  • DOI: https://doi.org/10.1007/s10143-013-0489-3

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