Neuropsychological rehabilitation in a patient with ruptured anterior communicating artery aneurysm: 48 month outcomes

Bolognani, Silvia A. Prado; Covre, Priscila; Landucci-Moreira, Daniella; Rivero, Thiago S.; Brucki, Sonia Maria Dozzi; Bueno, Orlando Francisco Amodeo

doi:10.1590/S1980-57642008DN10400014

Abstract

The neurobehavioral impairments associated with aneurysms of the anterior communicating artery (ACoA) are severe amnesia, executive problems and personality changes. Although most patients achieve a favorable neurological outcome, those cognitive deficits usually prevent return to previous activities and levels of social integration. Objectives: To report the outcomes of a neuropsychological and behavioral intervention in a 55 year-old man with very severe memory and executive dysfunctions following ACoA aneurysm rupture. Methods: Neuropsychological intervention focused in functional adjustment in everyday life was used, including individual sessions with the patient, discussion sessions with caregivers and also work with patient at home, aiming generalization of the rehabilitation strategies. Neuropsychological and functional assessments were conducted pre and post intervention. Results: Important improvements were seeing in behavior and daily living performance after treatment. Conclusions: A neuropsychological rehabilitation approach focused on goals based on the family and caregivers necessities is an efficient manner in which to carry out cognitive rehabilitation in severe cases. The importance of a supportive family should be stressed.

Key words:
neuropsychological rehabilitation; executive functions; amnesia; behavioral disturbances; activities of daily living

Resumo

Os prejuízos neuro-comportamentais associados a aneurismas de artéria comunicante anterior (ACoA) são amnésia severa, dificuldades executivas e alterações de personalidade. Embora muitos pacientes alcancem uma recuperação neurológica favorável, os prejuízos cognitivos acabam impedindo o retorno às atividades prévias e ao mesmo nível de integração social. Objetivos: Relatar os resultados de uma intervenção neuropsicológica e comportamental junto a um homem de 55 anos, com dificuldades severas de memória e funções executivas secundárias a ruptura de aneurisma de ACoA. Métodos: Foi empregada intervenção neuropsicológica com foco na adaptação funcional na vida diária. Foram realizadas sessões individuais com o paciente, sessões de discussão com cuidadores, além de trabalho com o paciente em casa, visando a generalização das estratégias de reabilitação. Foram realizadas avaliações neuropsicológica e funcional pré e pós-intervenção. Resultados: Foram observadas melhoras importantes no comportamento e no desempenho da vida diária após o tratamento. Conclusões: reabilitação neuropsicológica com foco nas necessidades dos familiares e cuidadores revelou-se eficiente maneira de realizar a reabilitação neuropsicológica em casos graves. A importância do apoio da família deve ser ressaltada.

Palavras-chave:
reabilitação neuropsicológica; funções executivas; amnésia; distúrbios comportamentais; atividades da vida diária

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References

¹
Clinchot DM, Bogner JA, Kaplan PE. Cerebral aneurysms: analysis of rehabilitation outcomes. Arch Phys Med Rehabil 1997;78:346-349.
²
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³
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⁴
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⁵
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⁶
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⁷
Beeckmans K, Vancoillie P, Michiels K. Neuropsychological deficits in patients with an anterior communicating artery syndrome: a multiple case study. Acta Neurol (Belg.) 1998;98:266-278.
⁸
Akyuz M, Erylmaz M, Ozdemir C, Goksu E, Ucar T, Tuncer R. Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery. Acta Neurol Scand 2005;112:293-297.
⁹
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¹⁰
Strauss E, Sherman EMS, Spreen O. A Compendium of neuropsychological tests: Administration, norms, and commentary. 3rd ed. New York: Oxford University Press; 2006.
¹¹
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¹²
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¹⁴
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¹⁶
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Publication Dates

Publication in this collection
Oct-Dec 2007

History

Received
31 Oct 2007
Reviewed
11 Nov 2007
Accepted
29 Nov 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Clinchot DM, Bogner JA, Kaplan PE. Cerebral aneurysms: analysis of rehabilitation outcomes. Arch Phys Med Rehabil 1997;78:346-349.

[2] ²
DeLuca J, Locker R. Cognitive rehabilitation following anterior communicating artery aneurysm bleeding: a case report. Disabil Rehabil 1996;18:265-72.

[3] ³
Simard S, Rouleau I, Brosseau J, Laframboise M, Bojanowskyc M. Impact of executive dysfunctions on episodic memory abilities in patients with ruptured aneurysm of the anterior communicating artery. Brain Cogn 2003;53:354-358.

[4] ⁴
Johnson MK, O'Connor M, Cantor J. Confabulation, Memory Deficits, and Frontal Dysfunction. Brain Cogn 1997;34:189-206.

[5] ⁵
Parkin A J, Yeomans J, Bindschaedler C. Further characterization of the executive memory impairment following frontal lobe lesions. Brain Cogn 1994;26:23-42.

[6] ⁶
Böttger S, Prosiegel M, Steiger HJ, Yassouridis A. Neurobehavioural disturbances, rehabilitation outcome, and lesion site in patients after rupture and repair of anterior communicating artery aneurysm. J Neurol Neurosurg Psychiatry 1998;65:93-102.

[7] ⁷
Beeckmans K, Vancoillie P, Michiels K. Neuropsychological deficits in patients with an anterior communicating artery syndrome: a multiple case study. Acta Neurol (Belg.) 1998;98:266-278.

[8] ⁸
Akyuz M, Erylmaz M, Ozdemir C, Goksu E, Ucar T, Tuncer R. Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery. Acta Neurol Scand 2005;112:293-297.

[9] ⁹
Wilson BA, Evans JJ, Keohane C. Cognitive rehabilitation: a goal-planning approach. J Head Trauma Rehabil. 2002;17:542-555.

[10] ¹⁰
Strauss E, Sherman EMS, Spreen O. A Compendium of neuropsychological tests: Administration, norms, and commentary. 3rd ed. New York: Oxford University Press; 2006.

[11] ¹¹
Wechsler D. Manual for the Wechsler Memory Scale-Revised. San Antonio (TX): Psychological Corporation; 1987.

[12] ¹²
Wechsler D. WAIS-R Manual: Wechsler Adult Intelligence Scale-Revised. New York (NY): Psychological Corporation; 1981.

[13] ¹³
Wechsler D. WAIS-III Manual: Wechsler Adult Intelligence Scale-3rd edition. New York (NY): Psychological Corporation; 1997.

[14] ¹⁴
Heaton RK, Chelune GJ, Talley JL, Kay GG, Curtiss G. Wisconsin Card Sorting Test Manual. Psychological Assessment Resources Inc; 1993.

[15] ¹⁵
Wilson BA. Neuropsychological Rehabilitation - Theory and Practice. Hove. Psychology Press; 2003.

[16] ¹⁶
Novack TA, Bush BA, Meythaler JM, Canupp K. Outcome after traumatic brain injury: pathway analysis of contributions from premorbid, injury severity, and recovery variables. Arch Phys Med Rehabil 2001;82:300-305.

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