Developing Topics.

Background: To explore the correlation between the topography of EPVS and cognitive impairment after aSAH.

Method: Patients clinically diagnosed as aSAH by DSA and CT; Head magnetic resonance imaging was performed between 1 week and 1 month after onset, combined with clinical and neuroimaging variables to assess the incidence of hydrocephalus and delayed cerebral ischemia after aneurystic subarachnoid hemorrhage. Follow-up was performed at 3 months, and the patients' prognosis and cognitive function were evaluated by mRS and the Montreal Cognitive Assesement (MoCA), respectively. The clinical characteristics of aSAH patients with EPVS <10 and EPVSV10 in basal ganglia and centrum semioval were compared, and a binary Logistic regression model was used to study the severity of EPVS and its correlation with DCI, subacute hydrocephalus, poor prognosis and cognitive impairment.

Result: BG-EPVS predominance pattern (BG-EPVS > CSO-EPVS) was more common in the aSAH group (53.8%) than in other primary SAH patients without aneurysm(15.8%). A total of 159 patients completed 3-month MoCA assessment, of which 63 (39.6%) were diagnosed with cognitive impairment (MoCA<22). EPVS >10 (no matter CSO or BG) was associated with unfavorable functional outcomes at 3 months. BG-EPVS >10 linked to subacute hydrocephalus and DCI, but not with cognitive impairment after adjusting for established predictors. In contrast, CSO-EPVS>10 predicted worse cognitive function after adjustment for established variables.

Conclusion: CSO-EPVS is associated with cognitive impair beyond aSAH, but not with subacute hydrocephalus and DCI, suggesting distinct lymphatic drainage and mechanism after an attack of aSAH.