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Open Access Research article

Cognition after malignant media infarction and decompressive hemicraniectomy - a retrospective observational study

Holger Schmidt12*, Trutz Heinemann3, Judith Elster1, Marija Djukic4, Stefan Harscher56, Katja Neubieser1, Hilmar Prange1, Andreas Kastrup7 and Veit Rohde8

Author Affiliations

1 University of Göttingen, Department of Neurology, Robert-Koch-Str. 40, D-37075 Göttingen, Germany

2 University of Göttingen, Department of Medical Psychology & Medical Sociology, Waldweg 37A, D-37075 Göttingen, Germany

3 Lichtenau Clinic, Department of Orthopedics, Am Mühlenberg, D-37235 Hessisch Lichtenau, Germany

4 Evangelisches Krankenhaus Göttingen Weende, Department of Geriatrics, An der Lutter 24, D-37075 Göttingen, Germany

5 Sophien- und Hufelandklinik, Department of Neurology, Henry-van-de-Velde-Straße 2, D-99425 Weimar, Germany

6 University of Jena, Department of Neurology, Erlanger Allee 101, D-07747 Jena, Germany

7 Klinikum Bremen-Mitte, Department of Neurology, St.-Jürgen-Str. 1, D-28177 Bremen, Germany

8 University of Göttingen, Department of Neurosurgery, Robert-Koch-Str. 40, D-37075 Göttingen, Germany

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BMC Neurology 2011, 11:77  doi:10.1186/1471-2377-11-77

Published: 23 June 2011



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.


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.


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.