Amnesia after basal forebrain damage due to anterior communicating artery aneurysm rupture

A 53-year-old male presented with a subarachnoid haemorrhage secondary to a n anterior communicating artery aneurysm rupture. The aneurysm was successf ully treated with intravascular coiling. Post-haemorrhage the patient showe d a profound amnestic syndrome with deficits in anterograde (and also retro grade) memory, confabulation and personality changes consistent,with the an terior communicating artery syndrome (ACAS). Magnetic resonance imaging sho wed basal forebrain and orbitofrontal infarction, The patient was treated w ith donepezil (a cholinesterase inhibitor) without symptomatic improvement or clinically meaningful change in his psychometric testing. The clinical a nd neuropsychological features and the pathological basis of the ACAS are r eviewed. (C) 1999 Harcourt Publishers Ltd.