B - 81 Neuropsychological Case Study: Transient Amnesia or "Sentinel Seizure?" Potential Prodromal Symptoms of an ACoA Aneurysm Rupture.

Abstract

We present the neuropsychological profile of a 33-year-old female with a history of transient amnestic events preceding frontal intraparenchymal/intraventricular hemorrhage, bilateral frontal cerebral edema and subarachnoid hemorrhage following a rupture of an anterior communicating artery aneurysm (ACoA). Comprehensive neuropsychological evaluation referral by neurology to assist with treatment planning given cognitive and behavioral changes since rupture of ACoA aneurysm. Prior to hospitalization, transient episodes of feeling as if she had been "drugged at a party," followed by behavior changes (e.g., irritability/agitation, "not herself") were notable, while the patient was amnestic to the events; spanning days at a time. Intellectual functioning was well-preserved. Neuropsychological testing revealed weaknesses in visuospatial organization, word retrieval, and aspects of executive functioning. Most salient were deficiencies in memory; patient was amnestic to tests shortly after administration. Striking emotional lability/frequent bouts of laughing disproportionate to the conversation and social comportment inappropriate to the setting were present. To our knowledge, amnestic events preceding ACoA aneurysm rupture have not been reported, and perhaps the symptoms this patient experienced prior to the event were indeed prodromal in nature. Therefore, the potentially rare phenomena in the form of transient amnesia should be further investigated. While these symptoms of memory lapses may be nonspecific and unique to the patient, we also cannot rule out possible "sentinel seizure" as a potential warning sign.