%0 Journal Article
%T Cognition after malignant media infarction and decompressive hemicraniectomy - a retrospective observational study
%A Holger Schmidt
%A Trutz Heinemann
%A Judith Elster
%A Marija Djukic
%A Stefan Harscher
%A Katja Neubieser
%A Hilmar Prange
%A Andreas Kastrup
%A Veit Rohde
%J BMC Neurology
%D 2011
%I BioMed Central
%R 10.1186/1471-2377-11-77
%X 20 patients from two different university hospitals (mean ¡À standard deviation: 52 ¡À 14 years of age) who had undergone hemicraniectomy with duraplasty above the non-speech dominant hemisphere at least one year previously were examined using a thorough neurological and neuropsychological work-up. The quality of life and the extent of psychiatric problems were determined on the basis of self-estimation questionnaires. The patients were asked whether they would again opt for the surgical treatment when considering their own outcome. 20 healthy persons matched for age, gender and education served as a control group.All patients but one were neurologically handicapped, half of them severely. Age was significantly correlated with poorer values on the Rankin scale and Barthel index. All cognitive domain z values were significantly lower than in the control group. Upon re-examination, 18 of 20 patients were found to be cognitively impaired to a degree that fulfilled the formal DSM IV criteria for dementia.Patients with non-speech dominant hemispheric infarctions and decompressive hemicraniectomy are at high risk of depression and severe cognitive impairment.For more than a century, trephining of the skull to relieve intracranial pressure due to brain swelling has been a treatment option for space-occupying lesions such as large brain infarctions in the area supplied by the middle cerebral artery (MCA) [1]. With modern intensive care, the mortality rate dropped to 70% [2], and decompressive hemicraniectomy (DCH) has reversed the ratio of survival and death as compared to a conservative treatment regime alone. Further studies showed improved survival rate with DCH and better functional outcome [3-5]. Other authors have investigated the quality of life (QoL) after extensive MCA infarction [6,7] but to our knowledge only Leonhardt et al. [8] sufficiently described neuropsychological problems in patients after DCH (n = 14). The majority of their patients showed unexpectedly goo
%U http://www.biomedcentral.com/1471-2377/11/77