Cerebral disconnection associated with anterior communicating artery aneurysm: implications for evaluation of...

The anterior communicating artery of a 34-year-old man was clipped to prevent a 2nd aneurysm bleed. Forty-five days later he was admitted to a rehabilitation program. On routine clinical examination, the patient demonstrated memory loss, disorientation, perceptual problems, decreased initiative, and inconsistent muscle control of the left limbs. Only during subsequent intensive testing did he demonstrate left-right conflict and asymmetric left-right performance consistent with a pattern of partial cerebral disconnection. Review of additional results, obtained during testing 8 months after onset, revealed reduction but not elimination of symptoms. The need to require bilateral response during evaluation of patients with potential asymmetric left-right performance is postulated.