S. Bottger et al., NEUROBEHAVIORAL DISTURBANCES, REHABILITATION OUTCOME, AND LESION SITEIN PATIENTS AFTER RUPTURE AND REPAIR OF ANTERIOR COMMUNICATING ARTERYANEURYSM, Journal of Neurology, Neurosurgery and Psychiatry, 65(1), 1998, pp. 93-102
Objective-To determine: (1) patterns of cognitive and psychiatric dysf
unction; (2) those neurobehavioural parameters which mostly influence
disability in activities of daily Living (ADL) and handicap in occupat
ional and psychosocial activities, and (3) underlying neuroanatomical
pathology in patients after rupture and repair of anterior communicati
ng artery (ACoA) aneurysm. Methods-30 patients were extensively examin
ed by means of a comprehensive battery of neuropsychological tests, by
rating of psychopathological symptoms, and by use of the functional i
ndependence measure (FIM), Glasgow outcome scale (GOS), and MRI. Resul
ts and conclusions-(1) Three main groups were characterised by primary
impairment of memory, executive functions, or of attentional performa
nce. Within these main groups, specific patterns were identified relat
ing to extent of primary dysfunction and associated disorders. The var
iety of neuropsychological disturbances is in contradiction to the exi
stence of an ''ACoA syndrome'' as an entity. (2) Rehabilitation outcom
e proved to be mostly associated with both memory and attentional perf
ormance. (3) In neuropathological terms, lesions of the medial septum
and nucleus of the diagonal band of Broca (MS/ndbB) were closely assoc
iated with memory deficits and prefrontal lesions were associated with
attentional, executive, and psychopathological dysfunctions. At the s
ame time, bilateral lesions were associated with severe disturbances.
The type and severity of the above mentioned deficits were independent
of the side of lesion in unilateral cases, of rectus gyrus resection,
and of the Hunt and Hess grading system.