Chu Alberto Chi Ho, Wong George Kwok Chu, Lam Sandy Wai, Wong Adrian, Ngai Karine, Poon Wai Sang, Mok Vincent
Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, 4/F Clinical Science Building, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR, China.
Acta Neurochir Suppl. 2015;120:303-6. doi: 10.1007/978-3-319-04981-6_51.
Cognitive deficits commonly occur after aneurysmal subarachnoid hemorrhage (aSAH) and clinical understanding is important for treatment and rehabilitation. Delayed cerebral infarction was shown to be related to poor outcome. Data on delayed cerebral infarction-related cognitive impairment were lacking.
We investigated the prevalence and pattern of delayed cerebral infarction-associated cognitive impairment.
We carried out a prospective observational and diagnostic accuracy study in Hong Kong in patients aged 21-75 years with aSAH who had been admitted within 96 h of ictus. The domain-specific neuropsychological assessment battery at 1 year after ictus was used for cognitive assessments. A cognitive domain deficit was defined as a cognitive domain z score less than -1.65 (below the fifth percentile). Cognitive impairment was defined by two or more cognitive domain deficits. The current study is registered at ClinicalTrials.gov of the U.S. National Institutes of Health (NCT01038193).
One hundred and twenty aSAH patients were recruited. Patients with delayed cerebral infarction (DCI) have cognitive impairment more frequently (22 % vs 11 %; odds ratio: 2.2, 0.6 to 7.8, p = 0.192). Cognitive domain deficits commonly affected in aSAH patients with delayed cerebral infarction were verbal memory, language, and visuospatial memory and skill domains, and were relatively uncommon in aSAH patients without delayed cerebral infarction.
In patients with aSAH, delayed cerebral infarction was associated with a specific pattern of cognitive domain deficits. The pathophysiology should be further investigated.
认知功能障碍在动脉瘤性蛛网膜下腔出血（aSAH）后普遍存在，临床认识对于治疗和康复很重要。延迟性脑梗死被证明与不良预后相关。关于延迟性脑梗死相关认知障碍的数据尚缺乏。
我们调查了延迟性脑梗死相关认知障碍的患病率及模式。
我们在香港对年龄在21 - 75岁、发病96小时内入院的aSAH患者进行了一项前瞻性观察和诊断准确性研究。在发病1年后使用特定领域的神经心理学评估量表进行认知评估。认知领域缺陷定义为认知领域z评分小于 -1.65（低于第五百分位数）。认知障碍由两个或更多认知领域缺陷定义。本研究已在美国国立卫生研究院的ClinicalTrials.gov注册（NCT01038193）。
招募了120例aSAH患者。发生延迟性脑梗死（DCI）的患者认知障碍更常见（22%对11%；优势比：2.2，0.6至7.8，p = 0.192）。延迟性脑梗死的aSAH患者中常见受影响的认知领域缺陷是言语记忆、语言以及视觉空间记忆和技能领域，而在无延迟性脑梗死的aSAH患者中相对不常见。
在aSAH患者中，延迟性脑梗死与特定模式的认知领域缺陷相关。其病理生理学应进一步研究。
