Abstract
Background: Cognitive impairment is the main factor affecting quality of life in patients with low-grade aneurysmal subarachnoid hemorrhage.Objective: We explored cognitive impairments and risk factors after treatment for ruptured anterior communicating artery (AComA) aneurysms in low-grade (Hunt-Hess grade of 1–3) patients without severe complications.Methods: One-hundred-twenty-six patients with a Hunt-Hess grade of 1–3 who underwent microsurgical clipping or endovascular embolization for ruptured AComA aneurysm treatment at three academic institutions in China from January 2015 to December 2017 were assessed with the modified Telephone Interview for Cognitive Status (TICS-m), the modified Rankin Scale (mRS), and the instrumental activities of daily living (IADL) scale 2 or more years after microsurgical clipping or endovascular coiling. Multiple cox-regression analysis was used to identify variables independently associated with cognitive impairment.Results: Of the total of 126 patients, 115 (91.3%) achieved good clinical outcomes (mRS score 0–2) and 109 (86.5%) had excellent quality of life (IADL score 8). Twenty-eight (22.2%) patients showed cognitive impairments (TICS-m≤27). The multivariate COX regression analysis showed that the female patients and longer duration of loss of consciousness at onset of subarachnoid hemorrhage (SAH) were independently associated with cognitive impairment. Cognitive outcome at the latest follow-up was not significantly different between patients treated after surgical clipping and coiling.Conclusion: About one in five patients showed cognitive impairments after treatment for ruptured AComA aneurysms. Patients who are of the female sex, and who have a longer duration of a loss of consciousness at the onset of SAH may be at risk of cognitive impairment.
Highlights
SAH is a devastating subtype of stroke affecting relatively young people who have a mean premorbid life expectancy of 30 years
Cognitive impairment may be a result of the transient cessation of circulation and the damage caused by blood entering the brain at the time of the aneurysm rupture [2, 3]
The inclusion criteria were as follows: [1] SAH caused by rupture of Anterior communicating artery (AComA) aneurysm, confirmed by CT scanning and by CT angiography or digital subtraction angiography and the modified Rankin Scale (mRS) scores 0∼2 in all patients before the aneurysmal subarachnoid hemorrhage (aSAH); [2] early treatment of ruptured AComA aneurysm by clipping or coiling; [3] no serious post-procedural complications, and functional recovery allowing the patient to participate in the comprehensive neuropsychological battery of tests; [4] a Hunt and Hess grade of 1∼3 at admission; [5] at least a primary school education level; and [6] post-operative followup for more than 2 years
Summary
SAH is a devastating subtype of stroke affecting relatively young people who have a mean premorbid life expectancy of 30 years. The AComA has several arterial branches that perfuse the basal forebrain, frontal lobe, anterior cingulate gyrus, septal nuclei, fornix, genu of the corpus callosum, and other neuroanatomical structures. Damage in both recent and remote memory, amnesia, confabulation, and personality changes were recorded as the main symptoms in the rupture of AComA aneurysms in earlier studies [4, 7]. Cognitive impairment is the main factor affecting quality of life in patients with low-grade aneurysmal subarachnoid hemorrhage
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
