Cognition and adjustment after late and early operation for ruptured aneurysm

Sonesson, Bengt; Ljunggren, Bengt; S??veland, H; Brandt, Lennart

doi:10.1097/00006123-198709000-00001

Cited by 31 publications

(62 citation statements)

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“…Among them the most relevant are patient characteristics like age, general condition, hypertension, multiple aneurysms, severity of SAH, the serious risks of vasospasm, recurrent haemorrhage and postoperative oedema, the experience of the surgeon, the technical equipment and the historical time of the surgery [2,3]. The combination of these variables and therapeutic options leads to variable case selection in different studies and outcome figures for therapeutic regimen vary considerably [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Beside the peri-operative results of early vs. late surgery there was some debate as to the long-term outcome [5,[12][13][14]. In most of the studies post-operative outcome is judged by simple three or five point global rating scales (independent, impaired, dead) three to six months after discharge [6,7,9].…”

Section: Introductionmentioning

confidence: 99%

“…Sonesson et al [5] investigated in a retrospective study with 55 ES and 38 LS patients with clinical grades I-III the impact of timing of operation on long-term cognitive performance and social adjustment. ES and LS patients were roughly matched by clinical conditions.…”

Section: Introductionmentioning

confidence: 99%

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Timing of operation for ruptured cerebral aneurysm and long-term recovery of cognitive functions

et al. 1995

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Advantage and disadvantages of early and late operation for ruptured cerebral aneurysm are controversially evaluated with regard to peri-operative operation outcome and long-term cognitive recovery. In this retrospective analysis 22 patients with early surgery (ES) within three days after subarachnoid haemorrhage (SAH) and 22 patients with late surgery (LS) at least 14 days after SAH were studied. Patients were pair-wise matched by degree of SAH localisation of aneurysm and age at SAH. On average three years after SAH both groups were examined individually with a comprehensive neuropsychological test battery including tests of premorbid intelligence, concept formation, memory, visuomotor speed, aphasia screening, and mood. ES and LS patients were well comparable in terms of years of education and level of premorbid intelligence. There was a clear influence of patients age on fluid intelligence tests, indicating a general change-sensitivity of tests. No influence of degree of SAH and localisation of aneurysm could be detected. There were also no differences between ES and LS patients in neuropsychological tests sensitive to brain damage, suggesting that the decision for early or late surgery for ruptured cerebral aneurysm can be based upon surgical reasons at the time of the SAH.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Timing of operation for ruptured cerebral aneurysm and long-term recovery of cognitive functions

et al. 1995

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“…O ''timing" da cirurgia, comparando cirurgia precoce (dentro de 72 horas) e cirurgia tardia (depois de 9 dias ou mais), não demonstrou diferença no desempenho cognitivo, sugerindo que os distúrbios na cognição estão na maior parte relacionados ao impacto inicial do HSA 17 . O ''timing" da cirurgia não pode ser correlacionado na presente série com as alterações neuropsicológicas tardias já que, pelo critério de seleção previamente definido, não pudemos obter uma casuística randomizada no grupo operado de 0-3 dias.…”

Section: Discussionunclassified

Desempenho cognitivo em pacientes operados de aneurisma cerebral

Fobe

Haddad²,

Souza

1999

Arq. Neuro-Psiquiatr.

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RESUMO -Vinte e cinco pacientes operados de aneurisma cerebral foram submetidos a avaliação cognitiva pós operatória tardia para linguagem, praxia, orientação, lógica, compreensão, memória, depressão, demência e gnosia visual. Os resultados foram correlacionados com idade, escala de Hunt-Hess à admissão, lado, local e tamanho do aneurisma, sangue à TC (Fisher), vaso-espasmo angiográfico (George). Déficit cognitivo tardio estava ausente em 8 pacientes (32%), era leve em 5 (20%), moderado em 6 (24%) e grave em 6 (24%). A função cognitiva isoladamente mais alterada foi a da lógica com acometimento moderado e grave em 7 pacientes (28%), seguida de praxia em 6 (24%), orientação em 5 (20%), linguagem e memória em 4 (16%). A alteração gnósica visual, demência e depressão foram pouco frequentes. A compreensão estava levemente alterada em 3 pacientes. Na faixa etária 25-50 anos ocorreu melhor resultado cognitivo com sequela inexistente ou leve em 9 pacientes (75%). Os aneurismas da artéria comunicante posterior direita apresentaram déficit cognitivo tardio ausente ou leve em 5 pacientes (71,42%), os da artéria cerebral média direita apresentaram resultado equivalente em 2 (66,66%). Os aneurismas de artéria cerebral média esquerda apresentaram o pior resultado com sequela cognitiva moderada e grave em 5 pacientes (71,42%). As sequelas neuropsicológicas tardias apresentaram correlação direta com a idade, Hunt-Hess, sangue à TC, vaso-espasmo angiográfico e localização anatômica do aneurisma. PALAVRAS-CHAVE: aneurisma intracraniano, hemorragia subaracnóidea, desempenho cognitivo, testes neuropsicológicos. Cognitive performance in patients with cerebral aneurysms submitted to surgeryABSTRACT -Twenty five patients with cerebral aneurysms submitted to surgery were evaluated with cognitive tests to quantify late disorders in language, praxis, orientation, logics, comprehension, memory, depression, dementia and visual gnosis. Results were correlated with age, Hunt-Hess scale, blood at CT (Fisher), angiographic vasospasm (George), side, site, and size of aneurysm. Delayed cognitive disorder was absent in 8 (32%), slight in 5 (20%), moderate in 6 (24%) and severe in 6 (24%). Logics was more affected with 7 severe and moderate patients (28%), praxis was similarly affected in 6 (24%), orientation in 5 (20%), language and memory in 4 (16%); visual gnosis abnormalities, dementia and depression were rarely seen. Patients aged 25-50 years had best cognitive results with sequels absent or slight in 9 patients (75%). Aneurysms of right posterior communicating artery had cognitive sequels absent or slight in 5 (71.42%), right medium cerebral artery in 2 (66,66%). Aneurysms of left medium cerebral artery had the worse results with severe and moderate disabilities in 5 patients (71.42%). Delayed post operative cognitive results in patients operated with cerebral aneurysms are directly related to Hunt-Hess scale, amount of blood at CT, angiographic vasospasm and site of the aneurysm.

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“…The causes of such cognitive impairment remain controversial, and the direct effects of aneurysm rupture, surgical factors and the location of the aneurysm have all been implicated [4,16,27,31]. These issues are unlikely to be resolved until a clearer understanding is achieved of the clinical factors associated with cerebral aneurysms that underlie cognitive deficits and until the cognitive outcome is consistently compared to measures of structural brain damage and regional cerebral blood flow.…”

Section: Introductionmentioning

confidence: 99%

Subcortical Hypoperfusion following Surgery For Aneurysmal Subarachnoid Haemorrhage: Implications For Cognitive Performance?

Tooth

Tindale

Hadjivassiliou

et al. 2000

Behavioural Neurology

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The incidence and severity of cognitive deficits after surgery for aneurysmal subarachnoid haemorrhage and their relationship to aneurysm site remains controversial. The aim of this study was to investigate the pattern of regional cerebral blood flow which exists in patients one year post-surgery and to identify whether different patterns exist which may be related to the type of cognitive deficit or the location of the aneurysm. 62 patients underwent cognitive assessment and HMPAO SPECT imaging at a mean time of 12 months following surgery. Results were compared to those from healthy control subjects (n = 55 for neuropsychological testing; n = 14 for SPECT imaging). In the patient group, significant stable cognitive deficits occurred in all cognitive domains but no cognitive measure differentiated aneurysm site. On SPECT images, statistical parametric mapping identified a large common area of subcortical hypoperfusion in the patient group as a whole. The findings of this study suggest a possible link between reduced subcortical function and the extent and severity of cognitive deficits.

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Cognition and adjustment after late and early operation for ruptured aneurysm

Cited by 31 publications

References 0 publications

Timing of operation for ruptured cerebral aneurysm and long-term recovery of cognitive functions

Timing of operation for ruptured cerebral aneurysm and long-term recovery of cognitive functions

Desempenho cognitivo em pacientes operados de aneurisma cerebral

Subcortical Hypoperfusion following Surgery For Aneurysmal Subarachnoid Haemorrhage: Implications For Cognitive Performance?

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