PT  - JOURNAL ARTICLE
AU  - Hadjivassiliou, M.
AU  - Tooth, C. L.
AU  - Romanowski, C. A.J.
AU  - Byrne, J.
AU  - Battersby, R. D.E.
AU  - Oxbury, S.
AU  - Crewswell, C. S.
AU  - Burkitt, E.
AU  - Stokes, N. A.
AU  - Paul, C.
AU  - Mayes, A. R.
AU  - Sagar, H. J.
TI  - Aneurysmal SAH
AID  - 10.1212/WNL.56.12.1672
DP  - 2001 Jun 26
TA  - Neurology
PG  - 1672--1677
VI  - 56
IP  - 12
4099  - http://n.neurology.org/content/56/12/1672.short
4100  - http://n.neurology.org/content/56/12/1672.full
SO  - Neurology2001 Jun 26; 56
AB  - Background: Aneurysmal subarachnoid hemorrhage (SAH) and surgical clipping of intracranial aneurysms are associated with substantial morbidity and mortality. Objective: To compare cognitive outcome and structural damage in patients with aneurysmal SAH treated with surgical clipping or endovascular coiling. Methods: Forty case-matched pairs of patients with aneurysmal SAH treated by surgical clipping or endovascular coiling were prospectively assessed by use of a battery of cognitive tests. Twenty-three case-matched pairs underwent MRI 1 year after the procedure. Matching was based on grade of SAH on admission, location of aneurysm, age, and premorbid IQ. Results: Both groups were impaired in all cognitive domains when compared with age-matched healthy control subjects. Comparison of cognitive outcome between the two groups indicated an overall trend toward a poorer cognitive outcome in the surgical group, which achieved significance in four tests. MRI showed focal encephalomalacia exclusively in the surgical group. This group also had a significantly higher incidence of single or multiple small infarcts within the vascular territory of the aneurysm, but both groups had similar incidence of large infarcts and global ischemic damage. Conclusion: Endovascular treatment may cause less structural brain damage than surgery and have a more favorable cognitive outcome. However, cognitive outcome appears to be dictated primarily by the complications of SAH.