Ravnik Janez, Starovasnik Barbara, Sesok Sanja, Pirtosek Zvezdan, Svigelj Viktor, Bunc Gorazd, Bosnjak Roman
Department of Neurosurgery, General Hospital Maribor, Maribor, Slovenia.
Croat Med J. 2006 Apr;47(2):253-63.
To evaluate long-term cognitive consequences of subarachnoid hemorrhage with good outcome and the opinion of patients and their relatives about these consequences.
The study included 10 patients surgically treated for subarachnoid hemorrhage due to the rupture of aneurysm of the anterior communicating artery 2 or more years earlier, and 10 age- and sex-matched healthy controls. The preoperative and postoperative course in the patients was uneventful. Clinical and psychosocial factors and cognitive status of the patients were assessed by use of checklists and neuropsychological tests for executive functions, attention, and memory, and event-related potential recordings (waves P3a and P3b) with tree-stimulus auditory oddball paradigm, which was also performed in healthy controls.
The number of reported cognitive problems negatively correlated with the patients' level of community integration (rho range, -0.22 to -0.75). The average neuropsychological results ranged between the 12th and 46th percentile. Impaired results were found in 7 patients across different tests and were most frequent for visual memory, followed by verbal memory and executive functions. A clear decline in cognitive functioning was observed in 3 patients. Neither P3a nor P3b wave could be found in 3 patients. In comparison with controls, patients had significantly longer P3b wave latencies (364 vs 334 ms; Mann-Whitney U test, P = 0.025). We found statistically non-significant, but still prominent negative correlations between the sustained attention results and latencies of P3a (rho = -0.58; P = 0.172) and P3b (rho = -0.58; P = 0.172) waves.
Despite good outcome after subarachnoid hemorrhage, persistent cognitive consequences were still manifest, limiting the patients' psychosocial functioning. The correlation between neuropsychological and neurophysiological measures indicated frontal lobe damage, which in some patients persisted for years after the hemorrhage.
评估预后良好的蛛网膜下腔出血的长期认知后果，以及患者及其亲属对这些后果的看法。
该研究纳入了10例因前交通动脉动脉瘤破裂导致蛛网膜下腔出血且在2年或更早之前接受手术治疗的患者，以及10例年龄和性别匹配的健康对照者。患者术前和术后过程均平稳。通过使用清单以及针对执行功能、注意力和记忆力的神经心理学测试，以及采用三项刺激听觉oddball范式进行的事件相关电位记录（P3a和P3b波）来评估患者的临床和社会心理因素以及认知状态，健康对照者也进行了此项测试。
报告的认知问题数量与患者的社区融入水平呈负相关（rho范围为-0.22至-0.75）。神经心理学平均结果在第12百分位至第46百分位之间。7例患者在不同测试中出现结果受损，其中视觉记忆受损最为常见，其次是言语记忆和执行功能。3例患者出现认知功能明显下降。3例患者未检测到P3a波和P3b波。与对照组相比，患者的P3b波潜伏期显著更长（364 vs 334毫秒；曼-惠特尼U检验，P = 0.025）。我们发现持续注意力结果与P3a波（rho = -0.58；P = 0.172）和P3b波（rho = -0.58；P = 0.172）潜伏期之间存在统计学上无显著意义但仍较为明显的负相关。
尽管蛛网膜下腔出血后预后良好，但仍存在持续的认知后果，限制了患者的社会心理功能。神经心理学和神经生理学测量之间的相关性表明存在额叶损伤，在一些患者中，这种损伤在出血后持续数年。
