title: Cognition after malignant media infarction and decompressive hemicraniectomy--a retrospective observational study.
abstract: BACKGROUND
  Decompressive hemicraniectomy is a life-saving procedure for patients with malignant middle cerebral artery infarctions. However, the neuropsychological sequelae in such patients have up to now received little attention. In this study we not only describe neuropsychological deficits but also the quality of life and the extent of depression and other psychiatric symptoms in patients after complete media infarction of the non-speech dominant hemisphere.
  
  
  METHODS
  20 patients from two different university hospitals (mean ± standard deviation: 52 ± 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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Patients with non-speech dominant hemispheric infarctions and decompressive hemicraniectomy are at high risk of depression and severe cognitive impairment.
authors.affiliation: University of Göttingen, Department of Neurology, Göttingen, Germany. H.Schmidt@med.uni-goettingen.de
authors.forename: Holger
authors.initials: H
authors.lastname: Schmidt
authors.forename: Trutz
authors.initials: T
authors.lastname: Heinemann
authors.forename: Judith
authors.initials: J
authors.lastname: Elster
authors.forename: Marija
authors.initials: M
authors.lastname: Djukic
authors.forename: Stefan
authors.initials: S
authors.lastname: Harscher
authors.forename: Katja
authors.initials: K
authors.lastname: Neubieser
authors.forename: Hilmar
authors.initials: H
authors.lastname: Prange
authors.forename: Andreas
authors.initials: A
authors.lastname: Kastrup
authors.forename: Veit
authors.initials: V
authors.lastname: Rohde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology*; D056424:Decompressive Craniectomy / Q000009:adverse effects*; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D014207:Trephining / Q000009:adverse effects*