Hillis A E, Anderson N, Sampath P, Rigamonti D
Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
J Neurol Neurosurg Psychiatry. 2000 Nov;69(5):608-15. doi: 10.1136/jnnp.69.5.608.
To determine the frequency and severity of neuropsychological impairments associated with aneurysmal subarachnoid haemorrhage, and associated with repair of intracerebral aneurysms.
Two groups of patients who underwent repair of intracerebral aneurysms were studied: patients with unruptured aneurysms (n=20) and patients with ruptured aneurysms (n=27). All patients were administered a battery of standardised neuropsychological tests about 3 months after surgery. A subset of 12 patients with unruptured aneurysms were administered the battery both before and after elective repair of the aneurysm(s). A subset of six patients with ruptured aneurysms were given the test at both 3 months and 1 year after surgery.
As previously reported for patients with ruptured aneurysms, patients with both ruptured and unruptured aneurysms performed, as a group, significantly below published norms on many of the neuropsychological tests after surgery. However, there were significant differences between preoperative and postoperative performance in the unruptured aneurysm group only on a few tests: measures of word fluency, verbal recall, and frontal lobe function. Performance of patients with ruptured aneurysms was significantly below that of patients with unruptured aneurysms only on a few tests of verbal and visual memory. In addition, group differences compared with published norms reflected severely impaired performance by a minority of patients, rather than moderately impaired performance in a majority of patients.
Although patients who undergo repair of ruptured aneurysms perform, as a group, below published norms on many neuropsychological tests, significant impairments are seen in a minority of patients. Some of the impairments are associated with subarachnoid haemorrhage, whereas others (found in patients who underwent repair of unruptured aneurysms) are due to general effects of neurosurgery and perioperative management. Finally, some of the postoperative deficits are merely a reflection of premorbid weaknesses.
确定与动脉瘤性蛛网膜下腔出血以及与脑内动脉瘤修复相关的神经心理学损伤的频率和严重程度。
对两组接受脑内动脉瘤修复的患者进行了研究：未破裂动脉瘤患者（n = 20）和破裂动脉瘤患者（n = 27）。所有患者在手术后约3个月接受了一系列标准化神经心理学测试。12例未破裂动脉瘤患者的一个子集在动脉瘤择期修复前后均接受了该系列测试。6例破裂动脉瘤患者的一个子集在手术后3个月和1年时均接受了测试。
如先前针对破裂动脉瘤患者所报道的那样，破裂和未破裂动脉瘤患者作为一个整体，在手术后的许多神经心理学测试中的表现均显著低于已发表的正常标准。然而，仅在少数测试中，未破裂动脉瘤组术前和术后的表现存在显著差异：词汇流畅性、言语回忆和额叶功能测试。仅在少数言语和视觉记忆测试中，破裂动脉瘤患者的表现显著低于未破裂动脉瘤患者。此外，与已发表标准相比的组间差异反映了少数患者的严重受损表现，而非大多数患者的中度受损表现。
尽管接受破裂动脉瘤修复的患者作为一个整体在许多神经心理学测试中的表现低于已发表的正常标准，但少数患者出现了显著损伤。其中一些损伤与蛛网膜下腔出血有关，而其他损伤（在接受未破裂动脉瘤修复的患者中发现）则是由于神经外科手术和围手术期管理的总体影响。最后，一些术后缺陷仅仅是病前弱点的反映。
