Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation

Abstract

The mortality rate has recently been reduced to only a small percentage of patients selected for early aneurysm surgery. Despite recovery without neurological deficits, however, a diffuse encephalopathy may remain, with emotional and psychological sequelae that will interfere with rehabilitation and social reintegration. The present study evaluates quality of life, degree of cognitive dysfunction, and adjustment of patients with a satisfactory neurological recovery after aneurysm operation in the acute stage following a major subarachnoid hemorrhage (SAH). Of 118 patients with a good neurological recovery, 40 patients were randomly sampled for a cross-sectional study and subjected to a questionnaire relating to their symptoms, a clinical interview, and a comprehensive neuropsychological investigation. The time interval between SAH and assessment varied between 14 months and 7 years, averaging 3 1/2 years. By means of standardized psychometric testing of intellectual capacity, memory functions, visuo-spatial abilities, perceptual speed and accuracy, and concept formation, degrees of cognitive impairment ranging from slight to severe dysfunction were identified. The results suggest that these disturbances may be permanent. The degree of impairment appeared to correlate with the patients' age. Interview data revealed substantial post-hemorrhagic maladjustment with respect to vitality, social management, self-assertion, emotional control, temperament, mood, and cognitive abilities. These findings were considerably at variance with the symptoms reported. It is stressed that, in the absence of gross neurological deficits, vital information on post-hemorrhage adjustment and impairment may easily be overlooked due to psychological defensive measures. It remains an open question whether post-SAH encephalopathy is enhanced by surgery performed in the acute stage.

Desempenho cognitivo em pacientes operados de aneurisma cerebral

“…O resultado cognitivo global foi satisfatório em 52% dos pacientes, acometimento ausente ou leve, sendo sobreponível aos relatos da literatura 3,4 . Embora exista grande variabilidade nos critérios de avaliação podemos concluir da importância da valorização da avaliação das funções cognitivas no pós operatório destes pacientes, compreendendo melhor todo o seu processo de reintegração familiar e social.…”

“…Os pacientes idosos evoluem de maneira bem menos satisfatória quanto ao déficit cognitivo, comportamental e social após HSA por aneurisma 3,4,23,24 . A idade influenciou diretamente o despenho cognitivo, sendo pior a sequela neuropsicológica tardia no grupo entre 50 e 65 anos, provavelmente devido a condições clínicas mais adversas pela idade e menor neuroplasticidade.…”

“…A identificação do déficit cognitivo através de testes neuropsicológicos não necessariamente fornece o quadro total de como o paciente poderá ser capaz para desempenhar as funções diárias, mas pode orientar na reabilitação e reintegração social, dando informações úteis aos seus familiares 1 . Apesar de boa recuperação motora pós cirúrgica, 65% 2 a 97,5% 3 de todos os pacientes têm algum grau de deterioração neuropsicológica, sendo a alteração cognitiva classificada como leve ou moderada em 30% a 53% destes pacientes 3,4 .…”

Gigantska aneurizma unutrašnje karotidne arterije, mogućnosti liječenja u zavisnosti od operativnog rizika

“…U prilog kongenitalnoj teoriji govori i udruženost aneurizmi na krvnim sudovima mozga sa drugim oboljenjima, policističnim oboljenjima bubrega, koarktacijom aorte, Marphan-ovim sindromom, oboljenjima vezivnog tkiva. Kongenitalne promjene predstavljaju samo jedan preduslov za nastanak manifestne aneurizme, pri čemu se mora naglasiti i značaj hemodinamskog udara krvne struje matičnog krvnog suda, uz povišen krvni pritisak, povišen holesterol, aterosklerozu, pušenja, korištenja droge, upotrebe oralnih kontraceptiva i dr. Najznačajnija i najopasnija posljedica prisustva aneurizme na krvnim sudovima mozga je pucanje (ruptura) njenog zida i krvarenje [3,4]. Krvarenje može biti u subarahnoidalnom prostoru -subarahnoidalna hemoragija (SAH) koja se javlja u 86% slučajeva, unutar moždanog parenhima (intracerebralna -IC hemoragija) u 34% slučajeva, u možda-nim komorama (intraventrikularna IV-hemoragija) u 13-28% slučajeva, a može da se javi pojedinačno ili u kombinaciji.…”

Subarachnoid hemorrhage as a psychological trauma

“…6,15,16,23,25,28,29,31,34,35,38 These psychological changes and subjective complaints are also present even when the degree of neurological and/or cognitive impairment is relatively mild. 15,16,23,25,[28][29][30][31]35,38 Ropper and Zervas 35 and Ljunggren et al 23 found that approximately 25% of their SAH patients with a good neurological result (Glasgow Outcome Scale [GOS] score of 1) exhibited substantial emotional maladjustment. The etiology of this psychosocial impairment has not been resolved conclusively.…”