Measuring of Cognitive Deficit after Cerebral Aneurysm Intervention

Authors: L. Krámská 1;  M. Preiss2 ,3;  J. Hradil 4
Authors‘ workplace: Neurologické oddělení, Nemocnice Na Homolce, Praha 1;  Psychiatrické centrum Praha 2;  University of New York, Praha 3;  Neurochirurgie, Krajská nemocnice Liberec, a. s. 4
Published in: Cesk Slov Neurol N 2012; 75/108(2): 185-190
Category: Original Paper


This study focuses on an assessment of cognitive functions in patients after cerebral artery aneurysm surgery. 

The main research problem is to obtain a valid assessment pertaining to the decrease of cognitive performance. Authors discuss routine clinical techniques which are applied in day to day practice in the Czech Republic – comparison of Full-Scale IQ with a reference norm and difference between verbal and performance IQ. Eighty out of the 168 patients were neuropsychologically evaluated for 1.7 years after the operation. 

The mean Full-Scale, Verbal and Performance IQ significantly decreased in comparison to the norm: 6.6 and 5 points, respectively. The mean difference between verbal and performance IQ was 0.5 points, p = 0.92. 

The authors point out some disadvantages of using WAIS-R in this group of patients:
lack of difference between verbal and performance intellect, probably caused by diffuse brain injury; old norms as a probable reason for absence of cognitive deficit in some patients, insufficient information about premorbid intelligence level (pre-surgery testing not possible). The authors recommend using a premorbid intelligence test in patients after neurosurgery interventions.

Key words:
subarrachnoid hemorrhagie – cerebral aneurysm – cognitive deficit – premorbid intellect


1. King JT jr, Horowitz MB, Kassam AB, Yonas H, Roberts MS. The short form-12 and the measurement of health status in patients with cerebral aneurysms: performance, validity and reliability. J Neurosurg 2005; 102(3): 489–494.

2. Dombovy ML, Drew-Cates J, Serdans R. Recovery and rehabilitation following subarachnoid haemor­rhage: part II long term follow up. Brain Inj 1998; 12(10): 887–894.

3. Hütter BO. Neuropsychological Sequelae of subarachnoid Hemorrhage. Vienna: Springer-Verlag 2000.

4. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet 1975; 1(7905): 480–484.

5. Kreiter KT, Copeland D, Bernardini GL. Predictors of cognitive dysfunction after subarrachnoid hemor­rhage. Stroke 2002; 33(1): 200–209.

6. Hütter B, Gilsbach J. Which neuropsychological deficits are hidden behind a good outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage? Neurosurgery 1993; 33(6): 999–1005.

7. Egge A, Waterloo K, Sjoholm H, Ingebrigsten T, Forsdahl S, Jacobsen EA et al. Outcome 1 year after aneurysmal subarachnoid hemorrhage: relation between cognitive performance and neuroimaging. Acta Neurol Scand 2005; 112(2): 76–80.

8. De Luca J. Cognitive dysfunction after aneurysm of the anterior communicating artery. J Clin Neuropsychol 1992; 14(6): 924–934.

9. Ogden JA, Mee EW, Henning M. A prospective study of impairment of cognition and memory and recovery after subarachnoid hemorrhage. Neurosurgery 1993; 33(4): 572–587.

10. Fertl E, Killer M, Eder H, Linzmayer L, Richling B, Auff E. Long-term functional effects of aneurysmal subarachnoid haemorrhage with special emphasis on the patient‘s view. Acta Neurochir (Wien) 199; 141(6): 571–577.

11. Berry E, Jones RAC, West CG, Brown JDK. Outcome of subarchnoid heamorrhage. An analysis of surgical variables, cognitive and emotional sequale related to SPECT scanning. Br J Neurosurgery 1997; 11(5): 378–387.

12. Mavaddat N, Sahakian BJ, Hutchinson PJ, Kirkpatrick PJ. Cognition following subarrachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery. J Neurosurg 1999; 91(3): 402–407.

13. Tidswell P, Dias PS, Sagar HJ, Mayes AR, Battersby RD. Cognitive outcome after aneurysm rupture: relationship to aneurysm site and perioperative complications. Neurology 1995; 45(5): 875–882.

14. Wechsler D. WAIS-III, WMS-III. Technical Manual. San Antonio: The Psychological Corporation 1997.

15. Říčan P, Šebek M, Vágnerová M. Wechslerův inteligenční test pro dospělé. Bratislava: Psychodiagnostické a didaktické testy 1983.

16. Lezak MD, Howieson DB, Loring DV. Neuropsychological Assessment. New York: Oxford University Press 2004.

17. Bryson GJ. Differential rate of neuropsychological dysfunction in psychiatric disorders: comparison between the Halstead-Reitan and Luria-Nebraska batteries. Percept Mot Skills 1993; 76(1): 305–306.

18. Ballard C, Stephens S, Kenny RA, Tovee KM, O’Brien J. Profile of neuropsychological deficits in older stroke survivors without dementia. Dement Geriatr Cogn Disord 2003; 16(1): 52–56.

19. Sonesson B, Ljunggren B, Saveland H. Cognition and adjustment and early operation for ruptured aneurysm. Neurosurgery 1987; 21(3): 279–287.

20. Bornstein RA, Weir BKA, Petruk KC, Disney LB. Neuropsychological function in patients after sub­arachnoid hemorrhage. Neurosurgery 1987; 21(5): 651–654.

21. De Santis A, Laiacona M, Barbarotto R. Neuropsychological outcome of patients operated upon for an intracranial aneurysm. J Neurol Neurosurg Psychiatry 1989; 52(10): 1135–1140.

22. Kim DH, Haney CL, Ginhoven GV. Utility of outcome measures after treatment for intracranial aneurysms: a prospective trial involving 520 patients. Stroke 2005; 36(4): 792–796.

23. Al-Khindi T, Macdonald RL, Schweizer TA. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke 2010; 41(8): e519–e536.

24. Proust F, Martinaud O, Gérardin E, Derrey S, Levèque S, Bioux S et al. Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. J Neurosurg 2009; 110(1): 19–29.

25. Vilkki J, Holst P, Ohman J, Servo A, Heiskanen O. Social outcome related to cognitive performance and computer tomographic findings after surgery for a ruptured intracranial aneurysm. Neurosurgery 1990; 26(4): 579–585.

26. Säveland H, Uski T, Sjöholm H, Sonnesson B, Brandt B. SPECT with technetium-99m-HMPAO in relation to late cognitive outcome for ruptured cerebral aneurysms. Acta Neurochir (Wien) 1996; 138(3): 301–307.

27. Flynn JR. What is intelligence? Beyond the Flynn Effect. Cambridge: Cambridge University Press 2007.

28. Krámská L. Možnosti měření premorbidního intelektu u pacientů po subarachnoidálním krvácení. Tvorba české verze zkoušky NART (dizertační práce). Praha: FF UK 2009.

29. Krámská L, Preiss M. Určování premorbidní úrovně – možnosti zkoušky čtení slov. Psychiatrie 2007; 11(1): 4–7.

30. Krámská L, Preiss M. Adaptation of the NART in Czech speakers – first experiences. J Int Neuropsychol Soc 2009; 15 (Suppl 2): 105.

31. Passier PE, Visser-Meily JM, Van Zandvoort MJ, Post MWM, Rinkel GJ, van Heugten C. Prevalence and Determinants of Cognitive Complaints after Aneurysmal Subarrachnoid Hemorrhage. Cerebrovasc Dis 2010; 29(6): 557–563.

32. Springer MV, Schmidt JM, Wartenberg KE, Frontera JA, Badjatia N, Mayer SA. Predictors of global cognitive impairment 1 year after subarachnoid hemorrhage. Neurosurgery 2009; 65(6): 1043–1051.

33. le Roux AA, Wallace MC. Outcome and Cost of Aneurysmal Subarachnoid Hemorrhage. Neurosurg Clin N Am 2010; 21(2): 235–246.

Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2012 Issue 2

Most read in this issue
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account