EMORRAGIA SUBARACNOIDEA: VALUTAZIONE NEUROPSICOLOGICA E CON RM 3T IN FASE PRECOCE: RISULTATI PRELIMINARI

TITLE: Subarachnoid Hemorrhage: cognitive evaluation and 3T MRI imaging in the acute phase; preliminary results AUTHOR: Giulio Andrea Bertani ABSTRACT INTRODUCTION: Aneurysmal subarachnoid hemorrhage (SAH) is a cerebrovascular disease characterized by high mortality and severe complications, in particular hydrocephalus and vasospasm. Traditional imaging techniques and outcome assessment scales (GOS, MRS) are unable to clarify the complex pathophysiological mechanisms of the disease or to adequately evaluate the impact on cognitive functions. AIMS: To investigate patients in the acute phase after SAH by advanced neuroimaging techniques (MRI) and in-depth neuropsychological evaluations, in order to assess acute cognitive deficits and to connect them to the numerous clinical and radiological variables which affect the course of the disease. METHODS: In the setting of a larger ongoing observational study, we selected 23 adult patients suffering from aneurysmal SAH. Following aneurysm treatment (clipping or coiling), patients underwent 3T brain MRI with MRA within 48 hours and 7-10 days, using a dedicated protocol; in the same times patient underwent neuropsychological assessments for language, memory, executive functions, praxis, orientation and personal autonomy. Monitoring of arterial flow by means of Transcranial Doppler (TCD) was performed. RESULTS: the majority of patients had marked cognitive deficits in all areas examined after SAH, with only marginal improvements at time 2. Early MRI showed ischemic volumes of less than 2 ml in 17 cases, between 2 and 10 ml in 3 and greater than 10 ml in 1; at T2 6 new lesions were detected, 5 less than 2 ml and 1 between 2 and 10 ml. The neuropsychological assessments showed multiple relationships with clinical and radiological parameters, location and side of the aneurysm, hydrocephalus and vasospasm; the correlation with ischemic lesions showed contradictory results. CONCLUSIONS: This study documents the pronounced cognitive impairment following SAH, despite a modest load in terms of ischemic lesions detected by MRI. It confirms that some features of the disease, such as the location and lateralization of the aneurysm, and the type of treatment have a deep influence on cognitive performances in the short term. This research also puts the basis for future selection of a battery of tests specifically designed to detect early subtle neuropsychological abnormalities, which are often associated with severe complications of SAH.