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Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study

  • Diagnostic Neuroradiology
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Abstract

Introduction

Cognitive impairment after aneurysmal subarachnoid hemorrhage (aSAH) is frequently detected. Here, we describe the pattern of cerebral (gray matter) atrophy and its clinical relevance after treatment of aSAH caused by a ruptured anterior cerebral artery (ACA) aneurysm.

Methods

Thirty-seven aSAH patients with ACA aneurysm (17 surgical, 20 endovascular treatment) and a good or moderate clinical outcome (Glasgow Outcome Scale V or IV) and 30 controls underwent brain MRI. Voxel-based morphometric analysis was applied to compare the patients and controls. Patients also underwent a detailed neuropsychological assessment.

Results

The comparisons between controls and either all patients (n = 37) or the subgroup of surgically treated patients (n = 17) revealed bilateral cortical atrophy in the frontal lobes, mainly in the basal areas. The brainstem, bilateral thalamic and hypothalamic areas, and ipsilateral caudate nucleus were also involved. Small areas of atrophy were detected in temporal lobes. The hippocampus and parahippocampal gyrus showed atrophy ipsilateral to the surgical approach. In the subgroup of endovascularly treated patients (n = 15), small areas of atrophy were detected in the bilateral orbitofrontal cortex and in the thalamic region. Twenty patients (54%) showed cognitive deficits in neuropsychological assessment.

Conclusion

Group analysis after aSAH and treatment of the ruptured ACA aneurysm revealed gray matter atrophy, principally involving the frontobasal cortical areas and hippocampus ipsilateral to the surgical approach. Areas of reduced gray matter were more pronounced after surgical than endovascular treatment. Together with possible focal cortical infarctions and brain retraction deficits in individual patients, this finding may explain the neuropsychological disturbances commonly detected after treatment of ruptured ACA aneurysms.

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Acknowledgments

The authors are grateful to the neuropsychologist Heleena Hurskainen who has performed all the neuropsychological evaluations. This study has been supported by the Kuopio University Hospital, grant 5063515, and Finnish Society of Radiology and Instrumentarium Foundation.

Conflict of interest statement

We declare that we have no conflict of interest.

Author contributions

The guarantors of integrity of entire study are Paula Bendel and Ritva Vanninen. Study concepts, design, and definition of intellectual concepts were done by P. Bendel, T. Koivisto, and R. Vanninen. Literature research was completed by P. Bendel. The study design and data analysis/interpretation and manuscript editing were carried out by all authors. Clinical studies were performed by P. Bendel T. Koivisto, M. Äikiä, T. Hänninen, and R. Vanninen. All authors took part in the data acquisition and data analysis. P. Bendel, E. Niskanen, and M. Könönen worked on the statistical analysis. All authors arranged the manuscript preparation and editing.

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Authors and Affiliations

  1. Department of Clinical Radiology, Kuopio University Hospital and University of Kuopio, Puijonlaaksontie 2, 70210, Kuopio, Finland

    Paula Bendel, Mervi Könönen, Päivi Koskenkorva & Ritva Vanninen

  2. Department of Neurosurgery, Kuopio University Hospital and University of Kuopio, Kuopio, Finland

    Timo Koivisto & Marja Äikiä

  3. Department of Neurology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland

    Eini Niskanen & Tuomo Hänninen

  4. Department of Physics, Kuopio University Hospital and University of Kuopio, Kuopio, Finland

    Eini Niskanen

  5. Department of Clinical Neurophysiology, Kuopio University Hospital and University of Kuopio, Kuopio, Finland

    Mervi Könönen

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  1. Paula Bendel
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  2. Timo Koivisto
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Correspondence to Paula Bendel.

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Bendel, P., Koivisto, T., Niskanen, E. et al. Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study. Neuroradiology 51, 711–722 (2009). https://doi.org/10.1007/s00234-009-0552-5

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  • DOI: https://doi.org/10.1007/s00234-009-0552-5

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