Topography and Predictitve Value of Enlarged Perivascular Spaces in Patients with Cognitive Impairment beyond Aneurysmal Subarachnoid Hemorrhage

Abstract 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.