Cognitive performance in patients with cerebral arteriovenous malformation

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OBJECTIVE

A cerebral arteriovenous malformation (cAVM) can change over time and cause symptoms, but clinical studies tend to define only the patients with ruptured cAVMs as symptomatic and do not consider neurocognitive aspects prior to neurosurgical intervention. The objective of this study was to describe the neurocognitive function of patients with ruptured and unruptured cAVMs according to the Spetzler-Martin (SM) grade, flow status, and anatomical topography.

METHODS

In this blinded cross-sectional study, 70 patients of both sexes and ages 18–60 years were evaluated using the Brazilian Brief Neuropsychological Assessment Battery Neupsilin.

RESULTS

Of the 70 patients with cAVMs, 50 (71.4%) demonstrated deficits in at least one of the eight neurocognitive domains surveyed, although they did not exhibit neurological deficits. cAVMs in the temporal lobe were associated with memory deficits compared with the general population. The SM grade was not significantly associated with the results of patients with unruptured cAVMs. However, among patients with ruptured cAVMs, there were deficits in working memory in those with high-grade (SM grade) cAVMs and deficits in executive function (verbal fluency) in those with low-grade cAVMs (p < 0.001).

CONCLUSIONS

This study indicates that patients with untreated cAVMs, either ruptured or unruptured, already exhibit neurocognitive deficits, even the patients without other neurological symptoms. However, the scales used to evaluate disability in the main clinical studies, such as A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA), do not assess neurocognitive alterations and therefore disregard any deficits that may affect quality of life. The authors’ finding raises an important question about the effects of interventional treatment because it reinforces the hypothesis that cognitive alterations may be preexisting and not determined by interventions.

ABBREVIATIONS cAVM = cerebral arteriovenous malformation; SM = Spetzler-Martin.

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Article Information

Correspondence Marcos Devanir Silva da Costa: Universidade Federal de São Paulo, Brazil. marcoscostaneuro@gmail.com.

INCLUDE WHEN CITING Published online April 12, 2019; DOI: 10.3171/2018.12.JNS181883.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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    Description of patients who did not meet the study inclusion criteria.

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    Descriptive analysis of neurocognitive deficits in patients with cAVM. The z score of the instrument (Neupsilin) was considered to indicate a deficit if it was 1 SD lower than the mean of the normal population. The y-axis represents the number of patients.

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