Neurocritical Care

, Volume 22, Issue 1, pp 6–14 | Cite as

Long-Term Outcome and Quality of Life After Craniectomy in Speech-Dominant Swollen Middle Cerebral Artery Infarction

  • Jarle SundsethEmail author
  • Antje Sundseth
  • Bente Thommessen
  • Lars G. Johnsen
  • Marianne Altmann
  • Wilhelm Sorteberg
  • Karl-Fredrik Lindegaard
  • Jon Berg-Johnsen
Original Article



Decompressive craniectomy in malignant middle cerebral artery infarction (MMCAI) reduces mortality. Whether speech-dominant side infarction results in less favorable outcome is unclear. This study compared functional outcome, quality of life, and mental health among patients with speech-dominant and non-dominant side infarction.


All patients undergoing decompressive craniectomy for MMCAI were included. Demographics, side of infarction, and speech-dominant hemisphere were recorded. Outcome at follow-up was assessed by global functioning (modified Rankin Scale score), neurological impairment (National Institutes of Health Stroke Scale score), dependency (Barthel Index), anxiety and depression (Hospital Anxiety and Depression scale), and quality of life (Short Form-36).


Twenty-nine out of 45 patients (mean age ± SD, 48.1 ± 11.6 years; 58 % male) were alive at follow-up, and 26 were eligible for analysis [follow-up, median (interquartile range): 66 months (32–93)]. The speech-dominant hemisphere was affected in 13 patients. Outcome for patients with speech-dominant and non-dominant side MMCAI was similar regarding neurological impairment (National Institutes of Health Stroke Scale score, mean ± SD: 10.3 ± 7.0 vs. 8.9 ± 2.7, respectively; p = 0.51), global functioning [modified Rankin Scale score, median (IQR): 3.0 [2–4] vs. 4.0 [3–4]; p = 0.34], dependence (Barthel Index, mean ± SD: 16.2 ± 5.0 vs. 13.1 ± 4.8; p = 0.12), and anxiety and depression (Hospital Anxiety and Depression scale, mean ± SD: anxiety, 5.0 ± 4.5 vs. 7.3 ± 5.8; p = 0.30; depression, 5.0 ± 5.2 vs. 5.9 ± 3.9; p = 0.62). The mean quality of life scores (Short Form-36) were not significantly different between the groups.


There was no statistical or clinical difference in functional outcome and quality of life in patients with speech-dominant compared to non-dominant side infarction. The side affected should not influence suitability for decompressive craniectomy.


Decompressive craniectomy Malignant Middle cerebral artery infarction Speech-dominant Outcome Quality of life 



Gidske and Peter Jacob Sørensens research foundation.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jarle Sundseth
    • 1
    • 2
    Email author
  • Antje Sundseth
    • 2
    • 3
  • Bente Thommessen
    • 3
  • Lars G. Johnsen
    • 4
    • 5
  • Marianne Altmann
    • 2
    • 3
  • Wilhelm Sorteberg
    • 1
  • Karl-Fredrik Lindegaard
    • 1
    • 2
  • Jon Berg-Johnsen
    • 1
    • 2
  1. 1.Department of NeurosurgeryOslo University Hospital RikshospitaletOsloNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Department of Neurology, Medical DivisionAkershus University HospitalLørenskogNorway
  4. 4.Department of Orthopedic SurgerySt. Olav’s University HospitalTrondheimNorway
  5. 5.Department of Neuroscience, Faculty of MedicineNorwegian University of Science and TechnologyTrondheimNorway

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