This dissertation aimed to investigate brain damage and cognitive consequences following aneurysmal (aSAH) and angiographically negative subarachnoid hemorrhages (anSAH).
The findings reveal that both types of hemorrhages lead to lasting cognitive impairments. Patients experience difficulties with memory, slowed psychomotor speed, and reduced attention and executive functions. These impairments remain largely stable from the subacute phase (3-6 months post-hemorrhage) to the chronic phase (2-4 years post-hemorrhage).
Using advanced MRI techniques, three key findings were identified: 1) significant volume reduction in the frontal lobe and enlargement of the lateral ventricles after both aSAH and anSAH, which are associated with decreased psychomotor speed and memory performance; 2) white matter abnormalities, particularly in aSAH patients, indicating disrupted communication between brain regions; and 3) high frequencies of cortical superficial siderosis, an accumulation of iron in the brain's cortex, observed in both types of hemorrhages.
Crucially, the anSAH group, despite traditionally being classified as a mild condition, also exhibits significant brain damage and persistent cognitive problems. This calls for a revision of the clinical approach, with greater emphasis on realistic communication regarding the potential long-term impact.
It is recommended that neuropsychological assessment becomes a standard part of aftercare for subarachnoid hemorrhage patients, so that patients and their families can be better informed about the possible long-term consequences, ultimately improving their recovery and well-being.
