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Quality of life and neurobehavioral changes in survivors of malignant middle cerebral artery infarction

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Abstract

Malignant middle cerebral artery (MMCA) infarction is associated with a mortality rate of 80% under conservative treatment. Decompressive hemicraniectomy (DH) reduces mortality and improves the functional outcome of surviving patients. The purpose of this study was to examine quality of life (QoL) and neurobehavioral deficits in patients with space-occupying infarctions of the right- or left-sided hemisphere at 6 months after stroke. The Sickness Impact Profile (SIP) was used to assess QoL in 19 out of 29 consecutive patients that underwent DH after a malignant MCA infarction (14 on the right and 5 on the left hemisphere). Behavioral changes were evaluated with the Frontal Behavioral Inventory and the Beck Depression Inventory. Patients and relatives were also asked if, knowing the present outcome, they would agree again, in retrospect, to a DH. Barthel Index >60 was seen in 37% of our patients. Functional outcome was related to age. We found a higher reduction in the SIP’s physical domain than in the psychosocial domain. Depressive symptoms were present in 50% of the patients. We didn’t find significant differences in QoL or functional outcome between patients with right or left-sided infarctions. The most frequent neurobehavioral symptoms were decreased speech output, apathy, reduced spontaneity and irritability. Most patients and their relatives would again give consent to hemicraniectomy. The results show that younger patients had a significantly better outcome. QoL seems to be acceptable in both left- and right-sided infarctions, and retrospective agreement to hemicraniectomy is high in both patients and their relatives.

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Acknowledgments

This study was supported by both the Fondo de Investigaciones Sanitarias de la Seguridad Social (FIS, grant no. 05/1092 received by Dr. J. Sahuquillo) and by the Fifth European Framework of the European Commission (SMILE project QLK1-CT-2002-02583). Bessy Benejam was awarded a predoctoral research grant from the Institut Fundació de Recerca Vall d’Hebron. We thank Dr. I. Bori and Dr. A. Amelivia from the Neurorehabilitation Department for taking care of the patients and for their continuous support of this study.

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Authors and Affiliations

  1. Neurosurgery and Neurotraumatology Research Unit, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

    Bessy Benejam, Juan Sahuquillo, Maria Antonia Poca & Elisabeth Solana

  2. Department of Neurosurgery, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Juan Sahuquillo & Maria Antonia Poca

  3. Institute of Diagnostic Imaging, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

    Laura Frascheri

  4. Department of Neurology, Vall d’Hebron University Hospital and Vall d’Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain

    Pilar Delgado

  5. Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain

    Carme Junqué

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  1. Bessy Benejam
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  2. Juan Sahuquillo
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Correspondence to Juan Sahuquillo.

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Benejam, B., Sahuquillo, J., Poca, M.A. et al. Quality of life and neurobehavioral changes in survivors of malignant middle cerebral artery infarction. J Neurol 256, 1126–1133 (2009). https://doi.org/10.1007/s00415-009-5083-9

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  • DOI: https://doi.org/10.1007/s00415-009-5083-9

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