&NA;Twenty patients who underwent early aneurysm surgery—that is, surgery within 72 hours after rupture—underwent further follow‐up examination including magnetic resonance imaging (MRI) of the brain and a comprehensive neuropsychological assessment. Significant statistical correlation between tissue loss as seen on a late MRI scan and neurobehavioral deficits could not be established. Among 9 patients with no tissue loss seen on MRI, 3 exhibited substantial cognitive dysfunction and 6 had mild impairment. Three patients showed minor but corresponding tissue loss and deficits. In 3 patients with pronounced pathological indications on MRI, evidence of cognitive dysfunction was absent in 2, and 1 patient showed substantial impairment. The remaining 5 individuals displayed moderate pathological indications on MRI, with no obvious correspondence to cognitive functioning. In 7 patients, small white matter lesions, probably silent infarcts not seen on computed tomographic scan, were discovered on MRI. There was a clear relationship between arterial hypertension prior to aneurysm rupture and the extent of tissue loss seen on MRI. Absence of pathological findings on MRI scan did not exclude cognitive malfunctioning, and vice‐versa. (Neurosurgery25:390‐397, 1989)