Cognitive impairment in angiographically negative subarachnoid haemorrhage: A case-matched prospective study 1-year post-incident

INTRODUCTION

Few studies investigate cognitive outcomes in patients with angiographically negative subarachnoid haemorrhage (anSAH), which is traditionally viewed as a condition with an excellent prognosis. The aim of this study was to assess neuropsychological outcomes in a prospective cohort of anSAH patients 1-year post-event.

METHOD

This prospective case-controlled study of cognitive function in patients with anSAH (n = 38) recruited from the national centre for neurosurgery and compared matched controls (n = 28). The cognitive battery assessed memory, executive function, attention, visuo-spatial function, processing speed, social cognition, language, and mood. Patients were matched to controls on age, education, and premorbid intelligence.

RESULTS

Multivariate Analysis of Variance (MANOVA) were used. Patients performed significantly worse than controls on all cognitive domain composite scores. anSAH patients had a higher frequency of impairment within encoding, executive, and processing speed domains when compared to healthy controls. Discriminant Function Analysis (DFA) indicated high sensitivity and specificity to detect cognitive impairment between groups.

CONCLUSION

Although the majority of patients with anSAH make an excellent physical recovery, our data show a high rate of cognitive dysfunction in patients 1-year post-incident. Cognitive impairment in anSAH is not a universal feature, and its manifestations may be more heterogeneous than previously recognised. Some impairment may be mediated by impaired speed of processing which negatively influences other cognitive domains. The profile of cognitive impairment supports a neurotoxicity hypothesis, which suggests that blood in the subarachnoid space, rather than the bleed per se, results in a diffuse pattern of cognitive deficits.

The eagle jugular syndrome

BACKGROUND

The elongation of the styloid process is historically associated with two variants of the Eagle syndrome. The classic one, mainly characterized by pain and dysphagia, and the carotid variant characterized by pain and sometimes by cerebral ischemia. We observed a further variant characterized by a styloid elongation coursing adjacent to the transverse process of C1, causing significant compression of the internal jugular vein.

METHODS

We reviewed all the cases of Eagle syndrome, including the jugular variant, admitted in our Hospital in the last six years. We compared symptomatology, associated comorbidities and imaging. Data were statistically analyzed.

RESULTS

Overall 23 patients were admitted to the Hospital for symptomatic elongation of the styloid process, 11 male and 12 females. The jugular variant of the Eagle syndrome is clinically delineated by significant differences, as compared to the classic variant and carotid variants. Headache was the more prominent symptom (p < .009) as well as a documented peri-mesencephalic hemorrhage was the more significant comorbidity (p < .0003). The group classic-carotid variant was characterized by ipsilateral pain respect to the jugular variant (p < .0003). CT angiography with venous phase extended to the neck veins and imaging reconstruction is highly recommended as imaging technique, complemented by color-Doppler ultrasound.

CONCLUSIONS

The elongation of the styloid process may have different paths which creates compression on the surrounding anatomical structures. There may be a possible association of jugular impingement by an elongated styloid process with symptoms.

TRIAL REGISTRATION

Protocol n°45-2013.