Paula Bendel MD, Presenter: Nothing to Disclose

Anni Kolehmainen, Abstract Co-Author: Nothing to Disclose

Mervi Kononen MSc, Abstract Co-Author: Nothing to Disclose

Timo Koivisto PhD, Abstract Co-Author: Nothing to Disclose

Corina Pennanen, Abstract Co-Author: Nothing to Disclose

Ritva Liisa Vanninen MD, Abstract Co-Author: Nothing to Disclose

After subaracnoid hemorrhage (SAH), half of the patients die and many are left with major neurological deficits or have milder neuropsychological disturbances. The aim of the present study was to assess, by using magnetic resonance imaging (MRI) volumetry, whether SAH and its treatment is followed by volume loss in temporomesial structures, often detected in elderly individuals with mild cognitive impairment.

Altogether 155 consecutive patients with aneurysmal SAH were prospectively included in the study. All patients were randomly assigned to surgical or endovascular treatment of the ruptured aneurysm. One year after SAH, all patients alive with no contraindications were scheduled for MRI and volumetry of the brain (n=86). Twenty-nine healthy individuals, matched for age and gender, were used as controls. A 3D-gradient-echo sequence and a semiautomatic volumetry analysis software (EasyMeasure, MariArc, Liverpool, GB) were used for volumetry of the right and left hippocampus (HC) and amygdala (AM). All measurements were performed by a single observer. All volumes were normalized for intracranial area.

The normalized HC volumes were 24.6/23.7 (right/left), and AM volumes 20.9/20.4 in the matched control population. In patients imaged one year after SAH the corresponding volumes were significantly smaller, HC 22.7/21.2 (p=0.024/0.003) and AM 18.0/18.9 (p=0.002/0.08). The AM volume ipsilateral to the ruptured aneurysm was significantly smaller than the contralateral AM volume. In addition, the ipsilateral AM volume was significantly smaller in patients who had undergone surgical treatment (16.0) than after endovascular treatment (19.9, p=0.02). Treatment modality did not significantly affect the measured HC volumes.

Subarachnoid hemorrhage and its treatment may be followed by atrophy in the temporomesial structures, detectable by MR volumetry. The mechanism of volume loss may be attributable to cerebral hypoperfusion caused by the initial bleeding, treatment procedure, or secondary vasospasm. In surgical patients, retraction injury may explain a part of AM volume loss. This observation might in part contribute to certain neuropsychological problems after SAH.

Bendel, P, Kolehmainen, A, Kononen, M, Koivisto, T, Pennanen, C, Vanninen, R, Subarachnoid Hemorrhage Is Followed by Temporomesial Volume Loss: MRI Volumetric Study One Year after Hemorrhage.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4412960.html