Abstract
BackgroundCerebral ischaemia is thought to be an important determinant of cognitive outcome after aneurysmal subarachnoid haemorrhage (aSAH), but the exact relationship is unclear. We studied the effect of ischaemic brain lesions during clinical course on cognitive outcome 2 months after aSAH.MethodsWe studied 74 consecutive patients admitted to the University Medical Center Utrecht who had MRI post-coiling (3–21 days post-aSAH) and neuropsychological examination at 2 months. An ischaemic lesion was defined as hyperintensity on T2-FLAIR and DWI images. We measured both cognitive complaints (subjective) and cognitive functioning (objective). The relationship between ischaemic brain lesions and cognitive outcome was analysed by logistic regression analyses.ResultsIn 40 of 74 patients (54%), 152 ischaemic lesions were found. The median number of lesions per patient was 2 (1–37) and the median total lesion volume was 0.2 (0–17.4) mL. No difference was found between the group with and the group without ischaemic lesions with respect to the frequency of cognitive complaints. In the group with ischaemic lesions, significantly more patients (55%) showed poor cognitive functioning compared to the group without ischaemic lesions (26%) (OR 3.4, 95% CI 1.3–9.1). We found no relationship between the number and volume of the ischaemic lesions and cognitive functioning.ConclusionsIschaemic brain lesions detected on MRI during clinical course after aSAH is a marker for poor cognitive functioning 2 months after aSAH, irrespective of the number or volume of the ischaemic lesions. Network or connectivity studies are needed to better understand the relationship between location of the ischaemic brain lesions and cognitive functioning.
Highlights
IntroductionPatients who survive an episode of aneurysmal subarachnoid haemorrhage (aSAH) often show good physical recovery, but many have cognitive complaints or impairments that hamper complex activities in daily life, such as work and social participation [1,2,3,4].Cerebral ischaemia plays a role in poor cognitive outcome after aSAH [5,6,7]
Patients who survive an episode of aneurysmal subarachnoid haemorrhage often show good physical recovery, but many have cognitive complaints or impairments that hamper complex activities in daily life, such as work and social participation [1,2,3,4].Cerebral ischaemia plays a role in poor cognitive outcome after aSAH [5,6,7]
The presence of ischaemic brain lesions was clearly related to an increased risk of developing cognitive deficits, within the group of patients with ischaemic brain lesions there was no relation between the number and volume of ischaemic lesions and cognitive functioning
Summary
Patients who survive an episode of aneurysmal subarachnoid haemorrhage (aSAH) often show good physical recovery, but many have cognitive complaints or impairments that hamper complex activities in daily life, such as work and social participation [1,2,3,4].Cerebral ischaemia plays a role in poor cognitive outcome after aSAH [5,6,7]. Cerebral ischaemia is thought to be an important determinant of cognitive outcome after aneurysmal subarachnoid haemorrhage (aSAH), but the exact relationship is unclear. We studied the effect of ischaemic brain lesions during clinical course on cognitive outcome 2 months after aSAH. An ischaemic lesion was defined as hyperintensity on T2-FLAIR and DWI images We measured both cognitive complaints (subjective) and cognitive functioning (objective). We found no relationship between the number and volume of the ischaemic lesions and cognitive functioning. Conclusions Ischaemic brain lesions detected on MRI during clinical course after aSAH is a marker for poor cognitive functioning 2 months after aSAH, irrespective of the number or volume of the ischaemic lesions. Network or connectivity studies are needed to better understand the relationship between location of the ischaemic brain lesions and cognitive functioning
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