NEUROBEHAVIORAL DISTURBANCES, REHABILITATION OUTCOME, AND LESION SITEIN PATIENTS AFTER RUPTURE AND REPAIR OF ANTERIOR COMMUNICATING ARTERYANEURYSM

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.