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ARTICLES: P. Bendel, T. Koivisto, T. Hänninen, A. Kolehmainen, M. Könönen, H. Hurskainen, C. Pennanen, and R. Vanninen Subarachnoid hemorrhage is followed by temporomesial volume loss: MRI volumetric study Neurology 2006; 67: 575-582 [Abstract] [Full text] [PDF]

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Subarachnoid hemorrhage is followed by temporomesial volume loss: MRI volumetric study

Alejandro A. Rabinstein   (25 October 2006)

Reply from the Authors

Paula Bendel, Timo Koivisto, Ritva Vanninen   (25 October 2006)

Subarachnoid hemorrhage is followed by temporomesial volume loss: MRI volumetric study 25 October 2006
Alejandro A. Rabinstein, Mayo Clinic 200 First Street SW Mayo W8B Rochester, MN 55905 Send Correspondence to journal: Re: Subarachnoid hemorrhage is followed by temporomesial volume loss: MRI volumetric study rabinstein.alejandro{at}mayo.edu Alejandro A. Rabinstein	Bendel et al reported an interesting study on the volume loss of temporomesial structures after aneurysmal subarachnoid hemorrhage. [1] The authors emphasize that amygdaloid atrophy was more prominent in patients treated with open surgery and provided evidence indicating that this finding may relate to retraction injury. However, hippocampal but not amygdaloid volumes correlated with deficits on neuropsychological tests. Furthermore, hippocampal volumes were unusually associated with intellectual functions other than memory. Considering these results, perhaps the authors could assess if the results of neuropsychological tests were associated with radiologically documented lesions in other brain structures, particularly the frontal white matter. This question is pertinent because damage to subcortical white matter in the frontal lobes is known to occur often after subarachnoid hemorrhage [2] and the neurocognitive deficits noted by the authors are similar to those expected with frontal lesions. References 1. Bendel P, Koivisto T, Hanninen T, et al. Subarachnoid hemorrhage is followed by temporomesial volume loss: MRI volumetric study. Neurology 2006; 67:575-582. 2. Kivisaari RP, Salonen O, Servo A, Autti T, Hernesniemi J, Ohman J. MR imaging after aneurysmal subarachnoid hemorrhage and surgery: a long -term follow-up study. AJNR Am J Neuroradiol 2001;22:1143-1148. Disclosure: The authors report no conflicts of interest.
Reply from the Authors 25 October 2006
Paula Bendel, Kuopio University Hospital, Department of Clinical Radiology Puijonlaaksontie 2, FI-70211 Kuopio, Finland, Timo Koivisto, Ritva Vanninen Send Correspondence to journal: Re: Reply from the Authors paula.bendel{at}kuh.fi Paula Bendel, et al.	We appreciate the interest of Dr. Rabinstein in our article. [1] He emphasizes the importance of radiologically documented lesions in brain structures other than temporomesial. Recent studies show that frontal high signal intensity lesions are often detected in T2-weighted images after SAH and the repair of the ruptured aneurysm.[2,3]. Furthermore, frontal lobe lesions are associated with neuropsychological impairments after SAH [4]. We concluded that temporomesial volume loss is frequently detected on MRI one year after SAH. [1] In our volumetric study population, we reported parenchymal high signal intensity lesions in 67.5% of the SAH-patients and these lesions were detected in the frontal lobes in 59.7% of the patients. The presence of a frontal high signal intensity lesion in the T2-weighted images was not significantly associated with the hippocampal volumes measured. As expected, the presence of a lesion in the frontal lobe(s) was associated with significantly worse results in the neuropsychological tests. We have further analyzed the correlations between the neuropsychological test results and hippocampal volumes separately in patients with and without a frontal lesion. We found significant correlations between impaired neuropsychological test results and reduced hippocampal volumes in both subgroups of the SAH-patients, suggesting that the detected hippocampal volume loss seems to be associated with impaired neuropsychological performance regardless of a possible co-existing MRI- detectable lesion in frontal lobe(s). Those correlations were seen in a larger number of the tests applied in patients with a frontal lobe lesion, indicating that the effect of the hippocampal volume loss is probably more pronounced in patients with a documented frontal lobe lesion. Although our recent article was focusing on the reduced temporomesial volumes after SAH, many patients have also other radiologically documented lesions on brain MRI. We assume that both the temporomesial volume loss and other local parenchymal lesions together contribute to the development of neurocognitive deficits which are often detected in patients after SAH. References 3. Hadjivassiliou M, Tooth CL, Romanowskiet CAJ, et al. Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling. Neurology 2001;56: 1672-1677. 4. Vilkki J, Holst P, Ohman J, Servo A, Heiskanen O. Cognitive deficits related to computed tomographic findings after surgery for a ruptured intracranial aneurysm. Neurosurgery 1989;25:166-172. Disclosure: The authors report no conflicts of interest.