COGNITIVE DEFICITS IN THE ACUTE STAGE AFTER SUBARACHNOID HEMORRHAGE

OBJECTIVE: In spite of fundamentally improved medical management of su barachnoid hemorrhage (SAH), many patients remain mentally impaired. H owever, the causes of these disturbances are unclear. The present stud y was performed to elucidate the significance of the hemorrhage itself and related events in the neuropsychological performance of patients in the acute stage after SAH. METHODS: A series of 51 patients were ex amined, by means of a battery of cognitive tests, 1 to 13 days (mean, 5.9 d) after SAH. Thirty-three patients had experienced ruptured aneur ysms, and 18 had sustained SAH of unknown origin. Furthermore, 25 pati ents who had undergone surgical treatment (a mean of 5.0 d earlier) of prolapsed lumbar discs served as a control group. RESULTS: The cognit ive deficits of the patients after aneurysmal SAH proved to be compara ble to those after spontaneous SAH of unknown origin, with the single exception of a significantly worse (P = 0.003) concentration capacity in the surgically treated group. The severity of SAH in computed tomog raphic scans correlated (up to r = 0.57, P < 0.001) with poor performa nce on tests of memory, concentration, divided attention, and persever ation. Frontal intracerebral hemorrhage led to significantly more erro rs in an aphasia screening test (P < 0.001) and a test of perseveratio n (P < 0.001). If acute hydrocephalus was present, the patients exhibi ted worse long-term memory (P < 0.001), showed slower reaction times ( P = 0.01), and made more errors in the perseveration test (P = 0.004). Patients with intraventricular blood performed at significantly lower levels in the concentration (P = 0.001), divided attention (P = 0.01) , long-term memory (P < 0.001), and perseveration (P = 0.003) tests. C ONCLUSION: The results emphasize that the severity of SAH (Fisher scor e) is the most important factor related to cognitive dysfunction, but frontal hematoma, intraventricular hemorrhage, and acute hydrocephalus were also associated with cognitive deficits, compared with patients with SAH without these findings.