Time-Course Of Neuropsychological Functioning In Aneurysmal Subarachnoid Haemorrhage And Its Association With Vasospasm

BackgroundAneurysmal Subarachnoid Haemorrhages (aSAH) are a severe condition often followed by vasospasm, causing several neurological and cognitive impairments in survivors. Nowadays there is still an open debate on actual impact of aSAH and vasospasm over cognitive abilities over time. This study aims at describing cognitive functioning focusing on the acute phases after bleeding and for 18 months, and to investigate the immediate and long-term effects of vasospasm. Methodsseventy adult patients have been prospectively recruited and were tested at different time points: within 48/72 hours from bleeding (T1); between 7 and 10 days after bleeding (T2); five long-term follow-ups from 1 (T3) to 18 months (T7). An extensive neuropsychological evaluation was administered, including memory, attentional and executive functions, language, praxis and level of daily functional independence. Half of the sample showed radiological vasospasm. Resultsresults show that at T1 all tests show high percentages of impairments (ranging from 38% to 100%), in particular for visual and verbal long-term memory, constructional praxis, abstract reasoning and functional independence. Many tasks gradually improve since T2, except for executive functions and visual memory which show a slower recovery. A severe diffuse impact of vasospasm emerges at T2 but, interestingly, a linear gradual recovery already since T3 emerges for almost all the investigated functions. At the last follow-ups several tests show no significant differences between patients with and without vasospasm. Conclusionsdespite a severe diffuse impact of bleeding and vasospasm in the acute stages, a low prevalence of cognitive and functional impairments at the chronic phase emerges. Our data may help to better understand the cognitive and autonomy trajectories of recover over time, a helpful element for clinicians to explain and reassure patients and relatives concerning real expectations of impairments and quality of life after the aSAH, and to tailor eventual rehabilitation programs.