Pathomechanisms behind cognitive disorders following ruptured anterior communicating aneurysms: A diffusion tensor imaging study - 20/10/21

Doi : 10.1016/j.neurad.2021.09.005

Kévin Premat ^a,^⁎ , Carole Azuar ^b, Damien Galanaud ^a, Alice Jacquens ^c, Didier Dormont ^a, Vincent Degos ^c, Frédéric Clarençon ^a
the ACOM Study Group^¹
ACOM Study Group: Eimad Shotar, Stéphanie Lenck, Nader Sourour, Aurélie Funkiewiez, Vincent Perlbarg, Grégory Torkomian, Louis Puybasset.
^a Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neuroradiology, F75013, Paris, France
^b Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Neurology, F75013, Paris, France
^c Sorbonne University, AP-HP, Pitié Salpêtrière - Charles Foix Hospital, Department of Anesthesiology and Critical Care, F75013, Paris, France

^⁎Corresponding author at: Department of Neuroradiology. Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.Department of NeuroradiologyPitié-Salpêtrière Hospital47-83 Boulevard de l'HôpitalParis75013France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 20 October 2021
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Abstract

Introduction

After the rupture of anterior communicating aneurysms, most patients experience debilitating cognitive disorders; and sometimes even without showing morphological anomaly on MRI examinations. Diffusion Tensor Imaging (DTI) may help understanding the pathomechanisms leading to such disorders in this subset of patients.

Methods

After independent assessment, we constituted a population of patients with normal morphological imaging (ACOM group). Then, a case-control study comparing volumetric and voxel-based DTI parameters between the ACOM group and a control population was performed. All patients underwent the full imaging and neuropsychological assessments at 6 months after the aneurysm rupture. Results were considered significant when p<2.02.10⁻⁴.

Results

Twelve patients were included in the ACOM group: 75% had at least one disabled cognitive domain. Significant differences in DTI parameters of global white matter were noted (average Fractional Anisotropy: 0.915 [±0.05] in ACOM group versus 0.943 (±0.03); p = 1.10⁻⁵) and in frontal white matter tracts (superior fronto-occipital fasciculus and anterior parts of the corona radiata) as well as in the fornix.

Conclusion

Cognitive disorders are under-estimated, and DTI confirmed that, even when conventional MRI examinations were normal, there were still signs of diffuse neuronal injuries that seemed to dominate in frontal areas, close to the site of rupture.

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