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Blaauw J, Hertog HMD, Holl DC, Thüss NS, van der Gaag NA, Jellema K, Dammers R, Kho KH, Groen RJM, Lingsma HF, Jacobs B, van der Naalt J. The cognitive status of chronic subdural hematoma patients after treatment: an exploratory study. Acta Neurochir (Wien) 2023; 165:701-709. [PMID: 36752891 PMCID: PMC10006248 DOI: 10.1007/s00701-023-05508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/29/2022] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common neurological condition, often affecting the elderly. Cognitive impairment is frequently observed at presentation. However, the course and longer term aspects of the cognitive status of CSDH patients are unknown. In this study, we aim to explore the cognitive status of CSDH patients after treatment. METHODS An exploratory study in which CSDH patients were assessed 3 months after treatment and compared to healthy controls. A total of 56 CSDH patients (age 72.1 SD ± 10.8 years with 43 [77%] males) and 60 healthy controls were included (age 67.5 ± SD 4.8 with 34 [57%] males). Cognitive testing was performed using the Telephonic Interview of Cognitive Status-modified (TICS-m), a 12-item questionnaire in which a total of 50 points can be obtained on several cognitive domains. RESULTS Median time between treatment and cognitive testing was 93 days (range 76-139). TICS-m scores of CSDH patients were significantly lower than healthy controls, after adjusting for age and sex: mean score 34.6 (95% CI: 33.6-35.9) vs. 39.6 (95% CI: 38.5-40.7), p value < 0.001. More than half (54%) of CSDH patients have cognitive scores at follow-up that correspond with cognitive impairment. CONCLUSION A large number of CSDH patients show significantly worse cognitive status 3 months after treatment compared to healthy controls. This finding underlines the importance of increased awareness for impaired cognition after CSDH. Further research on this topic is warranted.
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Affiliation(s)
- Jurre Blaauw
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands.
| | | | - Dana C Holl
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Nikki S Thüss
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Neurology, Subdepartment of Neuropsychology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Niels A van der Gaag
- Haaglanden Medical Center &, University Neurosurgical Center Holland (UNCH), Leiden University Medical Center, Haga Teaching Hospital, Leiden & The Hague, Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Centre, The Hague, Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, Netherlands
| | - Kuan H Kho
- Department of Neurosurgery, Medisch Spectrum Twente, NeurocenterEnschede, Netherlands
- Clinical Neurophysiology Group, Faculty of Science and Technology, University of Twente, Enschede, Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University Medical Center Groningen, Groningen, Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bram Jacobs
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Joukje van der Naalt
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Srinivas R, Naleer M, Kumar K. Assessment of cognition in chronic subdural hematoma patients using MMSE in preoperative and postoperative periods. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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3
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Weigel R, Schilling L, Krauss JK. The pathophysiology of chronic subdural hematoma revisited: emphasis on aging processes as key factor. GeroScience 2022; 44:1353-1371. [DOI: 10.1007/s11357-022-00570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/07/2022] [Indexed: 12/24/2022] Open
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Ishida T, Inoue T, Inoue T, Saito A, Suzuki S, Uenohara H, Tominaga T. Functional Outcome in Patients with Chronic Subdural Hematoma: Postoperative Delirium and Operative Procedure. Neurol Med Chir (Tokyo) 2022; 62:171-176. [PMID: 35296584 PMCID: PMC9093669 DOI: 10.2176/jns-nmc.2020-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a common neurosurgical condition and neurological condition improves after treatment in most patients. Recently more patients have poor prognosis because of aging of the population and presence of multiple comorbidities. The risk factors for poor prognosis, including postoperative delirium, were retrospectively evaluated to assess appropriate operative procedures. This study included 108 patients who underwent primary surgery from 2016 to 2017 at a single center. Operative procedures were drainage with or without irrigation. Functional outcome at discharge assessed the effect of various factors including postoperative delirium and operative procedure. Twenty-nine of 108 patients (27%) had worsened modified Rankin Scale (mRS) score at discharge, most with mobility disturbance or deteriorated cognitive function. Multivariate analysis found higher age (odds ratio [OR] = 5.13; 95% confidence interval [CI] = 1.0-1.14), poor pre-hospital mRS score (OR = 1.57; 95% CI = 1.0-2.46), and preoperative consciousness disturbance caused by CSDH (OR = 5.13; 95% CI = 1.27-20) were significant predictors of poor outcome. Operative procedure was not significantly related to functional outcome or recurrence, but irrigation was significantly related to postoperative delirium (OR = 4.83; 95% CI = 1.09-21.7). Patients with postoperative delirium were likely to require longer hospitalization stays (P = 0.028). Higher age, poor pre-hospital mRS, and preoperative consciousness disturbance caused by CSDH are the risk factors for poor recovery after CSDH. Irrigation is significantly likely to cause postoperative delirium and longer hospital stay.
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Affiliation(s)
- Tomohisa Ishida
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center
| | - Takashi Inoue
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center
| | - Tomoo Inoue
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center
| | - Atsushi Saito
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center
| | - Shinsuke Suzuki
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center
| | - Hiroshi Uenohara
- Department of Neurosurgery, National Hospital Organization Sendai Medical Center
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine
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Al-Salihi MM, Rahman MM, Al-Jebur MS, Rahman S. Letter: Middle Meningeal Artery Embolization Versus Conventional Treatment of Chronic Subdural Hematomas. Neurosurgery 2022; 90:e106-e107. [PMID: 35086981 DOI: 10.1227/neu.0000000000001858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Md Moshiur Rahman
- Department of Neurosurgery, Holy Family Red Crescent Medical College, Dhaka, Bangladesh
| | | | - Sabrina Rahman
- Department of Public Health, Independent University-Bangladesh, Dhaka, Bangladesh
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Blaauw J, Meelis GA, Jacobs B, Gaag NA, Jellema K, Kho KH, Groen RJ, Naalt J, Lingsma HF, den Hertog HM. Presenting symptoms and functional outcome of chronic subdural hematoma patients. Acta Neurol Scand 2022; 145:38-46. [PMID: 34448196 DOI: 10.1111/ane.13518] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with chronic subdural hematoma (CSDH) can present with a variety of signs and symptoms. The relationship of these signs and symptoms with functional outcome is unknown. Knowledge of these associations might aid clinicians in the choice to initiate treatment and may allow them to better inform patients on expected outcomes. OBJECTIVE To investigate if presenting signs and symptoms influence functional outcome in patients with CSDH. METHODS We conducted a retrospective analysis of consecutive CSDH patients in three hospitals. Glasgow Outcome Scale Extended (GOS-E) scores were obtained from the first follow-up visit after treatment. An ordinal multivariable regression analysis was performed, to assess the relationship between the different signs and symptoms on the one hand and functional outcome on the other adjusted for potential confounders. RESULTS We included 1,307 patients, of whom 958 (73%) were male and mean age was 74 (SD ± 11) years. Cognitive complaints were associated with lower GOS-E scores at follow-up (aOR 0.7, 95% CI: 0.5 - 0.8) Headache and higher Glasgow Coma Scale (GCS) scores were associated with higher GOS-E scores. (aOR 1.9, 95% CI: 1.5-2.3 and aOR 1.3, 95% CI: 1.2-1.4). CONCLUSION Cognitive complaints are independently associated with worse functional outcome, whereas headache and higher GCS scores are associated with better outcome. The increased probability of unfavorable outcome in patients with CSDH who present with cognitive complaints favors a more prominent place of assessing cognitive status at diagnosis.
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Affiliation(s)
- Jurre Blaauw
- Department of Neurology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
- Center for Medical Decision Sciences Department of Public Health Erasmus Medical Center Rotterdam The Netherlands
| | | | - Bram Jacobs
- Department of Neurology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
| | - Niels A. Gaag
- University Neurosurgical Center Holland (UNCHLeiden University Medical CenterHaaglanden Medical Center & Haga teaching hospitalLeiden & The Hague The Hague The Netherlands
| | - Korné Jellema
- Department of Neurology Haaglanden Medical Centre The Hague The Netherlands
| | - Kuan H. Kho
- Department of Neurosurgery Medisch Spectrum Twente Enschede The Netherlands
| | - Rob J.M. Groen
- Department of Neurosurgery University Medical Center Groningen Groningen The Netherlands
| | - Joukje Naalt
- Department of Neurology University of GroningenUniversity Medical Center Groningen Groningen The Netherlands
| | - Hester F. Lingsma
- Center for Medical Decision Sciences Department of Public Health Erasmus Medical Center Rotterdam The Netherlands
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A matter of frailty: the modified Subdural Hematoma in the Elderly (mSHE) score. Neurosurg Rev 2021; 45:701-708. [PMID: 34231088 PMCID: PMC8827338 DOI: 10.1007/s10143-021-01586-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/05/2021] [Accepted: 06/14/2021] [Indexed: 10/27/2022]
Abstract
The Subdural Hematoma in the Elderly (SHE) score was developed as a model to predict 30-day mortality from acute, chronic, and mixed subdural hematoma in the elderly population after minor or no trauma. Emerging evidence suggests frailty to be predictive of mortality and morbidity in the elderly. In this study, we aim to externally validate the SHE for chronic subdural hematoma (CSDH) alone, and we hypothesize that the incorporation of frailty into the SHE may increase its predictive power. A retrospective cohort of elderly patients with CSDH after minor or no trauma being treated at our institution was evaluated with the SHE. Thirty-day mortality and outcome were documented. Patients were assessed with the Clinical Frailty Scale (CFS), which was incorporated into a modified SHE (mSHE). Both the SHE and the mSHE were then assessed in their predictive powers through receiver operating characteristic statistics. We included 168 patients. Most (n = 124, 74%) had a favorable outcome at 30 days. Mortality was low at n = 7, 4%. The SHE failed to predict mortality (AUC = .564, p = .565). Contrarily, the mSHE performed well in both mortality (AUC = .749, p = .026) and outcome (AUC = .862, p < .001). A threshold of mSHE = 3 is predictive of mortality with a sensitivity of 50% and a specificity of 75% and of poor outcome with a sensitivity of 88% and a specificity of 64%. Frailty should be routinely evaluated in elderly individuals, as it can predict outcome and mortality, providing the possibility for medical, surgical, nutritional, cognitive, and physical exercise interventions.
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Katsuki M, Yasuda I, Narita N, Ozaki D, Sato Y, Kato Y, Jia W, Nishizawa T, Kochi R, Sato K, Kawamura K, Ishida N, Watanabe O, Cai S, Shimabukuro S, Yokota K. Chronic subdural hematoma in patients over 65 years old: Results of using a postoperative cognitive evaluation to determine whether to permit return to driving. Surg Neurol Int 2021; 12:212. [PMID: 34084639 PMCID: PMC8168661 DOI: 10.25259/sni_186_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Chronic subdural hematoma (CSDH) is usually associated with good recovery with burr hole irrigation and postoperative drainage under local anesthesia. In Japan, traffic accidents by the elderly drivers over 65 years old are severely increasing, and there is no consensus on whether or not to return to driving after CSDH treatment. We perform a postoperative cognitive assessment. We retrospectively investigated the return-to-driving rate and associated factors. Methods: Of the 45 patients over 65 y.o. and who had usually driven, 30 patients wished to drive again. We performed tests composed of Mini-Mental State Examination (MMSE), line cancellation and line bisection task, Kohs block design test, trail making test (TMT)-A and B, Kana-hiroi test, Rey-Osterrieth complex figure test, and behavioral assessment of the dysexecutive syndrome, in order. When all tests’ scores were better than the cutoff values, we let patients drive again. When some of the scores were worse than the cutoff values, we reevaluated the patients at the outpatient every month. If the patients’ scores could not improve at the outpatient, we recommended them to stop driving. Results: Nineteen of 30 patients could return to driving. Worse MMSE, Kohs block design test, TMT-A, TMT-B scores, higher age, dementia, or consciousness disturbance as chief complaints were associated with driving disability. Conclusion: CSDH is known as treatable dementia. However, we should perform an objective cognitive assessment before discharge because only 63% of the patients over 65 y.o. who wished to drive could return to driving.
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Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Iori Yasuda
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Dan Ozaki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yoshimichi Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yuya Kato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Wenting Jia
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Taketo Nishizawa
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Ryuzaburo Kochi
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kanako Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kokoro Kawamura
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Naoya Ishida
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Ohmi Watanabe
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Siqi Cai
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Shinya Shimabukuro
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kenichi Yokota
- Department of Rehabilitation, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
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Scerrati A, Pangallo G, Dughiero M, Mongardi L, Ricciardi L, Lofrese G, Dones F, Cavallo MA, De Bonis P. Influence of nutritional status on the clinical outcome of patients with chronic subdural hematoma: a prospective multicenter clinical study. Nutr Neurosci 2021; 25:1756-1763. [PMID: 33666524 DOI: 10.1080/1028415x.2021.1895480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Elderly patients present a higher risk of developing chronic subdural hematomas (CSDHs) together with increased risk of malnutrition. The nutritional status may affect outcomes, response to treatments, and prognosis. Influence on other kinds of diseases was investigated showing an increased risk of mortality, morbidity, and adverse outcomes. However, no studies are available on its possible role for the outcome of patients with CSDH. This study aims to evaluate a possible relationship between the nutritional status and the clinical outcome of patients who underwent CSDH surgery. METHODS This is a multicenter prospective study enrolling all patients treated for CSDH. Demographic and clinical data were collected. For nutritional status evaluation, we used the Mini Nutritional Assessment (MNA). Chi-square test was used for comparing clinical variables of patients and logistic regression analysis was used for defining the impact of the aforementioned variables on the clinical outcome. RESULTS We enrolled 178 patients. Modified Rankin scale (mRS) was 0-2 pre-operatively in 23.6% of patients and post-operatively in 61.2% of patients. Total assessment MNA score was >23.5 in 47.8% of patients. Ninety-three patients (52.2%) presented a normal nutritional status, 63 (35.4%) were at risk of malnutrition and 22 (12.4%) were malnourished. The mean follow-up was 2.6 months. Malnourished patients were at higher risk of a worse outcome (OR 81; CI = 9-750). CONCLUSION This study suggests that nutritional status represents a strong predictor of outcome. Our results, albeit preliminary, demonstrated malnutrition is correlated to the risk of worse clinical outcome for patients undergoing surgery for chronic subdural hematoma. Further investigations with wider casuistry and multiple nutritional scores are required to validate our data.
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Affiliation(s)
- Alba Scerrati
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Giulia Pangallo
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Michele Dughiero
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Luca Ricciardi
- Neurosurgery Unit, Pia Fondazione di Culto e Religione Cardinal G. Panico, Tricase, Italy
| | - Giorgio Lofrese
- Neurosurgery Division, "M. Bufalini" Hospital, Cesena, Italy
| | - Flavia Dones
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy
| | - Michele Alessandro Cavallo
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Pasquale De Bonis
- Department of Neurosurgery, Sant' Anna University Hospital, Ferrara, Italy.,Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
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Blaauw J, Boxum AG, Jacobs B, Groen RJM, Peul WC, Jellema K, Dammers R, van der Gaag NA, Lingsma HF, den Hertog HM, van der Naalt J. Prevalence of Cognitive Complaints and Impairment in Patients with Chronic Subdural Hematoma and Recovery after Treatment: A Systematic Review. J Neurotrauma 2020; 38:159-168. [PMID: 32873143 DOI: 10.1089/neu.2020.7206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Chronic subdural hematoma (CSDH) is a frequently occurring neurological disease associated with older age and use of anticoagulants. Symptoms vary from headaches to coma, but cognitive deficits can also be present. However, exact prevalence and severity of cognitive deficits in CSDH are still unknown. In this systematic review, we aim to assess cognitive status of patients with CSDH, at presentation and after treatment. PubMed, Embase and PsycInfo were searched for articles concerning cognition in CSDH. We divided cognitive changes into subjective cognitive deficit (cognitive complaints [CC]) and objective cognitive deficit (cognitive impairment [CI]). Two reviewers independently selected studies for inclusion and subsequently extracted data. Quality assessment was done by means of the Newcastle-Ottawa Scale. Reported prevalence of CC and CI was pooled with random effects meta-analysis. Out of 799 identified references, 22 met inclusion criteria. Twenty-one articles reported on prevalence of CC/CI and one study reported solely on CSDH patients with cognitive deficit. Estimated pooled prevalence of both CC and CI in CSDH at presentation was 45% (95% confidence interval [CI]: 36-54%). Four studies concerned a prospective evaluation of the effect of surgical treatment on cognition. These proved to be of fair to good quality after quality assessment. The estimated pre-treatment prevalence of objectified cognitive impairment was 61% (95% CI: 51-70%) decreasing to 18% (95% CI: 8-32%) post-surgery. From this review it can be concluded that CC and CI are very common in CSDH, with a tendency to improve after treatment. Therefore, we underline the importance of increased attention to cognitive status of these patients, with proper testing methods and treatment-testing intervals.
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Affiliation(s)
- Jurre Blaauw
- Department of Neurology and University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anke G Boxum
- Department of Neurology, Isala Hospital Zwolle, Zwolle, The Netherlands
| | - Bram Jacobs
- Department of Neurology and University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rob J M Groen
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wilco C Peul
- University Neurosurgical Center Holland (UNCH), Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niels A van der Gaag
- University Neurosurgical Center Holland (UNCH), Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospital, Leiden and The Hague, The Netherlands
| | - Hester F Lingsma
- Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Joukje van der Naalt
- Department of Neurology and University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Gill M, Maheshwari V, Narang A, Lingaraju TS. Impact on Cognitive Improvement Following Burr Hole Evacuation of Chronic Subdural Hematoma: A Prospective Observational Study. J Neurosci Rural Pract 2019; 9:457-460. [PMID: 30271033 PMCID: PMC6126321 DOI: 10.4103/jnrp.jnrp_126_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective: Patients of Chronic subdural haematoma can present with only subtle cognitive impairment without any motor deficit. It is hence imperative for the treating clinician to be aware of this entity. The aim of the study was to identify any statistically significant improvement of cognitive functions following burr hole evacuation of Chronic SDH especially in the elderly patients. Methods and Material: A Prospective observational study of 30 patients of CSDH, from Jan 2015 to Dec 2016 was done at a tertiary level Armed Forces Hospital. The study had 23 male, 07 female, with age ranging from 7-85 years. The cognitive function of each patient was assessed at admission and 24 hours after surgery by MMSE. Radiological confirmation was done by CT head. Standard two burr holes were made and hematoma evacuated. The clinical, cognitive assessment and radiological data were collected and analysed. Results: There was no statistical significance preoperatively between age and pre operative cognitive impairment, headache, hemiparesis, dysarthria (P>0.05). We however found a statistically significant improvement postoperatively in cognitive impairment, headache (P= 0.00), motor deficit (P=0.01) and dysarthria (P=0.046). Conclusion: The clinical features of dementia and other neurodegenerative disorders simulate CSDH in the geriatric population. These patients should have early neuroimaging and prompt surgical intervention to alleviate cognitive deficits.
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Affiliation(s)
- Maneet Gill
- Department of Neurosurgery, Armed Forces Medical College, Pune, Maharashtra, India
| | - Vikas Maheshwari
- Department of Neurosurgery, Armed Forces Medical College, Pune, Maharashtra, India
| | - Amit Narang
- Department of Neurosurgery, Armed Forces Medical College, Pune, Maharashtra, India
| | - T S Lingaraju
- Department of Neurosurgery, Armed Forces Medical College, Pune, Maharashtra, India
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Moffatt CE, Hennessy MJ, Marshman LA, Manickam A. Long-term health outcomes in survivors after chronic subdural haematoma. J Clin Neurosci 2019; 66:133-137. [DOI: 10.1016/j.jocn.2019.04.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/23/2019] [Accepted: 04/28/2019] [Indexed: 10/26/2022]
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Shimizu K, Sadatomo T, Hara T, Onishi S, Yuki K, Kurisu K. Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma. Geriatr Gerontol Int 2018; 18:1173-1176. [DOI: 10.1111/ggi.13436] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/19/2018] [Accepted: 04/04/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Kiyoharu Shimizu
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Takashi Sadatomo
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Takeshi Hara
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Shumpei Onishi
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Kiyoshi Yuki
- Department of Neurosurgery; Higashihiroshima Medical Center; Hiroshima Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical Sciences; Hiroshima University; Hiroshima Japan
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14
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Sahyouni R, Goshtasbi K, Mahmoodi A, Tran DK, Chen JW. Chronic Subdural Hematoma: A Perspective on Subdural Membranes and Dementia. World Neurosurg 2017; 108:954-958. [PMID: 28935547 PMCID: PMC5705282 DOI: 10.1016/j.wneu.2017.09.063] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To review the complex pathogenesis of the subdural membrane and the link between head trauma, dementia, and dural lymphatics. METHODS A thorough literature search of published English-language articles was performed using PubMed, Ovid, and Cochrane databases. RESULTS Chronic subdural hematoma (cSDH) is a common intracranial pathology and a leading cause of reversible dementia. cSDH is projected to affect at least 60,000 new individuals in the United States annually by 2030. This condition can result from mild to moderate head trauma that leads to hemorrhaging in the dura-arachnoid interface. The short-term and long-term effects of cSDH and the subdural membrane on the pathogenesis of dementia and the newly discovered dural lymphatics is a topic of increasing importance. CONCLUSIONS Further research into the possible link between traumatic brain injury and cSDH in particular and dural lymphatics and intracranial fluid dynamics is warranted.
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Affiliation(s)
- Ronald Sahyouni
- University of California, Irvine, School of Medicine, Irvine, California, USA; Department of Biomedical Engineering, University of California, Irvine, Samueli School of Engineering, Irvine, California, USA
| | - Khodayar Goshtasbi
- University of California, Irvine, School of Medicine, Irvine, California, USA
| | - Amin Mahmoodi
- Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA
| | - Diem Kieu Tran
- Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA
| | - Jefferson W Chen
- Department of Neurological Surgery, University of California, Irvine, Irvine, California, USA.
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Sahyouni R, Goshtasbi K, Mahmoodi A, Tran DK, Chen JW. Chronic Subdural Hematoma: A Historical and Clinical Perspective. World Neurosurg 2017; 108:948-953. [PMID: 28935548 DOI: 10.1016/j.wneu.2017.09.064] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND This review aims to highlight the clinical complexity of chronic subdural hematoma (cSDH) while presenting a brief historical discussion of cSDH. METHODS A thorough literature search of published English-language papers was performed in PubMed, Ovid, and Cochrane databases. RESULTS cSDH affects 1-5.3 per 100,000 individuals annually, with the incidence expected to rise as the U.S. population ages. The symptoms of cSDH are often nonspecific, with headaches being the most common complaint. Other symptoms include weakness, balance and gait problems, and memory problems. CONCLUSIONS A variety of clinical factors must be taken into account in the treatment of cSDH, and the multifaceted treatment paradigms continue to evolve.
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Affiliation(s)
- Ronald Sahyouni
- UC Irvine School of Medicine, Irvine, California, USA; UC Irvine Department of Biomedical Engineering, Irvine, California, USA
| | | | - Amin Mahmoodi
- UC Irvine Department of Neurological Surgery, Irvine, California, USA
| | - Diem K Tran
- UC Irvine Department of Neurological Surgery, Irvine, California, USA
| | - Jefferson W Chen
- UC Irvine Department of Neurological Surgery, Irvine, California, USA.
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Schoedel P, Bruendl E, Hochreiter A, Scheitzach J, Bele S, Brawanski A, Schebesch KM. Restoration of Functional Integrity After Evacuation of Chronic Subdural Hematoma—An Age-Adjusted Analysis of 697 Patients. World Neurosurg 2016; 94:465-470. [DOI: 10.1016/j.wneu.2016.07.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/06/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
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Abstract
Vascular dementia (VaD) is a major contributor to the dementia syndrome and is described as having problems with reasoning, planning, judgment, and memory caused by impaired blood flow to the brain and damage to the blood vessels resulting from events such as stroke. There are a variety of etiologies that contribute to the development of vascular cognitive impairment and VaD, and these are often associated with other dementia-related pathologies such as Alzheimer disease. The diagnosis of VaD is difficult due to the number and types of lesions and their locations in the brain. Factors that increase the risk of vascular diseases such as stroke, high blood pressure, high cholesterol, and smoking also raise the risk of VaD. Therefore, controlling these risk factors can help lower the chances of developing VaD. This update describes the subtypes of VaD, with details of their complex presentation, associated pathological lesions, and issues with diagnosis, prevention, and treatment.
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Affiliation(s)
- Ayesha Khan
- Wolfson Centre for Age Related Diseases, Guys Campus, London, United Kingdom of Great Britain and Northern Ireland Institute of NanoBioTechnology, Johns Hopkins University, Baltimore, MD, USA
| | - Raj N Kalaria
- Institute for Ageing and Health, Wolfson Research Centre, Campus for Ageing & Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anne Corbett
- Wolfson Centre for Age Related Diseases, Guys Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Clive Ballard
- Wolfson Centre for Age Related Diseases, Guys Campus, London, United Kingdom of Great Britain and Northern Ireland
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Arca R, Ricchi V, Murgia D, Melis M, Floris F, Mereu A, Contu P, Marrosu F, Melis M, Cossu G. Parkinsonism and dementia are negative prognostic factors for the outcome of subdural hematoma. Neurol Sci 2016; 37:1299-303. [PMID: 27120071 DOI: 10.1007/s10072-016-2588-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
To determine, among a population with subdural hematoma (SH), whether patients affected by neurodegenerative disorders (parkinsonism and dementia) have a worse clinical outcome. We reviewed the data of patients diagnosed with fall-related SH discharged from the Departments of Neurology/Stroke unit, Neurosurgery, Intensive Care Unit at Brotzu General Hospital (Cagliari, Italy) between January 2010 and December 2013. Patients with severe traumatisms, evidence of spontaneous intracerebral bleeding or aged less than 50 were excluded. 332 patients were selected: 69 with a neurodegenerative parkinsonism or dementia (N-group), 217 with history of chronic non-neurological medical conditions with significant disability, previous falls and/or balance problems (NND-group) and 46 with a history of "minor" chronic non-neurological disorder. (NN-group). The clinical status at admission and discharge was assessed by modified Rankin Scale (mRS). The time-span between trauma and hospital admission was also calculated. At hospital admission we found a significantly longer delay in SH's diagnosis (χ (2) test p < 0.001) and a worse mRS score (Kruskal Wallis p < 0.001) in the N-group compared to both NN and NND-groups. During hospital stay we observed the lack of significant variation in mRS score in N-group (Wilcoxon test p = 0.86), in contrast with NN and NND-groups who significantly improved (Wilcoxon test p < 0.001). Our results demonstrate that the consequences of SH are more severe in the N-group compared to NN and NND-groups. The longer interval between trauma and hospital admittance plays a critical role in worsening the outcome of patients with parkinsonism and dementia compared to subjects without neurodegenerative disorders.
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Affiliation(s)
- Roberta Arca
- Neurology Service and Stroke Unit, Department of Neuroscience, AOB "G. Brotzu" General Hospital, P.le Ricchi, 1, 09134, Cagliari, Italy
| | - Valeria Ricchi
- Neurology Service and Stroke Unit, Department of Neuroscience, AOB "G. Brotzu" General Hospital, P.le Ricchi, 1, 09134, Cagliari, Italy
| | - Daniela Murgia
- Neurology Service and Stroke Unit, Department of Neuroscience, AOB "G. Brotzu" General Hospital, P.le Ricchi, 1, 09134, Cagliari, Italy
| | - Marta Melis
- Department of Neurology, Azienda Universitario Ospedaliera di Cagliari, University of Cagliari, Cagliari, Italy
| | - Francesco Floris
- Neurosurgery Unit, Department of Neuroscience, AO Brotzu, Cagliari, Italy
| | - Alessandra Mereu
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Paolo Contu
- Department of Public Health, University of Cagliari, Cagliari, Italy
| | - Francesco Marrosu
- Department of Neurology, Azienda Universitario Ospedaliera di Cagliari, University of Cagliari, Cagliari, Italy
| | - Maurizio Melis
- Neurology Service and Stroke Unit, Department of Neuroscience, AOB "G. Brotzu" General Hospital, P.le Ricchi, 1, 09134, Cagliari, Italy
| | - Giovanni Cossu
- Neurology Service and Stroke Unit, Department of Neuroscience, AOB "G. Brotzu" General Hospital, P.le Ricchi, 1, 09134, Cagliari, Italy.
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Abstract
BACKGROUND Several sets of diagnostic criteria have been published for vascular dementia since the 1960s. The continuing ambiguity in vascular dementia definition warrants a critical reexamination. METHODS Participants at a special symposium of the International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2009 critiqued the current criteria. They drafted a proposal for a new set of criteria, later reviewed through multiple drafts by the group, including additional experts and the members of the Neurocognitive Disorders Work Group of the fifth revision of Diagnostic and Statistical Manual (DSM-5) Task Force. RESULTS Cognitive disorders of vascular etiology are a heterogeneous group of disorders with diverse pathologies and clinical manifestations, discussed broadly under the rubric of vascular cognitive disorders (VCD). The continuum of vascular cognitive impairment is recognized by the categories of Mild Vascular Cognitive Disorder, and Vascular Dementia or Major Vascular Cognitive Disorder. Diagnostic thresholds are defined. Clinical and neuroimaging criteria are proposed for establishing vascular etiology. Subtypes of VCD are described, and the frequent cooccurrence of Alzheimer disease pathology emphasized. CONCLUSIONS The proposed criteria for VCD provide a coherent approach to the diagnosis of this diverse group of disorders, with a view to stimulating clinical and pathologic validation studies. These criteria can be harmonized with the DSM-5 criteria such that an international consensus on the criteria for VCD may be achieved.
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Soucy JP, Bartha R, Bocti C, Borrie M, Burhan AM, Laforce R, Rosa-Neto P. Clinical applications of neuroimaging in patients with Alzheimer's disease: a review from the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia 2012. Alzheimers Res Ther 2013; 5:S3. [PMID: 24565260 PMCID: PMC3980588 DOI: 10.1186/alzrt199] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In May 2012, the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia brought together in Montreal experts from around Canada to update Canadian recommendations for the diagnosis and management of patients with neurodegenerative conditions associated with deterioration of cognition. Multiple topics were discussed. The present paper is a highly condensed version of those recommendations that were produced to support discussions in the field of neuroimaging for clinical diagnosis of those conditions.
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Affiliation(s)
- Jean-Paul Soucy
- PET Unit, McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec, Canada H3A 2B4
| | - Robert Bartha
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Christian Bocti
- Service de Neurologie, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Michael Borrie
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Amer M Burhan
- Department of Medicine, Division of Geriatric Medicine, Western University, London, Ontario, Canada
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, Université Lava, Quebec, Quebec, Canada
| | - Pedro Rosa-Neto
- Translational Neuroinmaging Laboratory, McGill Centre for Studies in Aging, Douglas Research Institute, McGill University, Montreal, Quebec, Canada
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Abstract
Subjective memory concerns are common in older adults and may prompt the use of web-based cognitive screening. Websites which purport to provide memory screening are numerous and can influence health behaviours; however there is currently limited evidence regarding their validity. The current research aims to assess potential user's attitudes and motivations regarding online cognitive screening and to evaluate the preliminary evidence for the feasibility and validity of two subjective online cognitive measures. The sample consisted of community-based older adults, 30 with, and 30 without, memory concerns. Participants rated their likelihood of their accessing online cognitive screening and gave rationales. Participants' performance on objective pen and paper measures of cognition was compared to performance on subjective online screening measures. The majority of participants indicated they would access online cognitive screening. A total of 100% of participants were able to use the online tools without assistance. None of the online measures was positively associated with the pen and paper screening measures. Anxiety and depression were significantly associated with subjective memory concerns. This study provided no supporting evidence for the validity of either subjective online screening measure assessed. Anxiety and depression were significantly associated with subjective cognition, indicating that, although they may not predict objective cognition, complaints about memory in older adults should be taken seriously by health professionals.
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Affiliation(s)
- J Young
- Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia
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22
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Hématome sous-dural chronique et décompensation psychotique. Encephale 2012; 38:356-9. [DOI: 10.1016/j.encep.2011.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 06/06/2011] [Indexed: 11/18/2022]
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23
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Osuka S, Matsushita A, Ishikawa E, Saotome K, Yamamoto T, Marushima A, Satou N, Zaboronok A, Masumoto T, Matsumura A. Elevated diffusion anisotropy in gray matter and the degree of brain compression. J Neurosurg 2012; 117:363-71. [PMID: 22680241 DOI: 10.3171/2012.4.jns112305] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT For several decades, clinicians have predicted intraparenchymal brain pressure or brain tissue compression indirectly based on the degree of distortion of the midline structures (midline shift) and ventricle wall (ventriculomegaly) observed on conventional MRI. However, this method has several limitations. Diffusion tensor imaging (DTI) is a novel MRI technique that can provide information about the microstructural properties of compressed tissue. In this study, the authors evaluated whether DTI can precisely define the degree of tissue compression in patients with chronic subdural hematoma (CSDH). METHODS The study sample consisted of 18 patients (mean age 71 years, 10 men and 8 women) with unilateral CSDH and 12 age-matched volunteers. Diffusion tensor imaging results were acquired before and after the surgical irrigation in the CSDH group. Subdural pressure during the operation was also measured. Fractional anisotropy (FA) values were evaluated at several locations, including the gray matter. RESULTS The FA values of the gray matter, especially in the caudate nucleus and putamen, were increased in the patients with CSDH compared with the control group. The change in FA data before and after surgery (ΔFA) correlated with the degree of tissue compression evaluated by measurement of the subdural pressure. Furthermore, the increased FA values in patients with CSDH decreased after surgery. CONCLUSIONS These findings indicate that FA values of the gray matter, especially in the caudate nucleus and putamen, may be important markers of tissue compression. The assessment of FA values of the gray matter will result in a new, less-invasive diagnostic technique to evaluate the degree of brain compression.
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Affiliation(s)
- Satoru Osuka
- Department of Neurosurgery, University of Tsukuba, Tsukuba, Japan
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Kim SH. Surgically treatable dementia. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2012. [DOI: 10.5124/jkma.2012.55.3.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Seong Ho Kim
- Department of Neurosurgery, Yeungnam University College of Medicine, Daegu, Korea
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Ishikawa E, Yamamoto M, Saito A, Kujiraoka Y, Iijima T, Akutsu H, Matsumura A. DELAYED CYST FORMATION AFTER GAMMA KNIFE RADIOSURGERY FOR BRAIN METASTASES. Neurosurgery 2009; 65:689-94; discussion 694-5. [PMID: 19834373 DOI: 10.1227/01.neu.0000351771.46273.22] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
Gamma knife radiosurgery (GKRS) is occasionally a useful tool for maintaining good brain status in patients with brain metastases (METs). Conversely, we recently experienced patients with delayed cyst formation (DCF) several years after GKRS, a complication not previously reported. Herein we assessed the frequency and characteristics of DCF after GKRS for METs.
METHODS
Eighty of 1209 patients with METs treated with GKRS maintained good brain status for more than 3 years without regrowth of tumorous lesions in the brain. In this study, DCF was defined as secondary cyst formation more than 3 years after the first GKRS in patients with METs who did not have cysts at the start of MET treatment. The 80 patients were divided into 2 groups (DCF group and non-DCF group) for assessment of the frequency and characteristics of DCF. Of the patients with cystic METs at the start of MET treatment, 16 were included in the latter group.
RESULTS
Among these 80 patients, 8 had DCF after GKRS (DCF group), detected by magnetic resonance imaging from 37 to 121 months after the first GKRS (median interval of 53 months). Of these 8 patients, 7 were symptomatic, and surgical treatments including Ommaya reservoir placement were needed in 5. A comparison of the non-DCF and DCF groups revealed that a higher number of GKRS treatments was a risk factor for DCF. Moreover, patients surviving more than 5 years after the initial GKRS are at risk for DCF.
CONCLUSION
Although DCF is not a widely recognized complication of GKRS for METs, we advocate careful follow-up, with surgical intervention for DCF if necessary, for frequently irradiated and long-surviving patients with METs treated with GKRS.
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Affiliation(s)
- Eiichi Ishikawa
- Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | | | - Atsushi Saito
- Department of Neurosurgery, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Yuji Kujiraoka
- Department of Neurosurgery, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Tatsuo Iijima
- Department of Pathology, Ibaraki Prefectural Central Hospital, Kasama, Japan
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Institute of Clinical Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
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Kawahira K, Shimodozono M, Ogata A, Etoh S, Ikeda S, Yoshida A, Tanaka N, Tsujio S. IMPAIRED VISUO-MOTOR SKILLS IN THE UNAFFECTED LOWER LIMB OF PATIENTS WITH STROKE. Int J Neurosci 2009; 115:1315-32. [PMID: 16048808 DOI: 10.1080/00207450590934561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To study the motor skills of the unaffected lower limb of patients with stroke, the visuo-motor skills of the unaffected lower limb in patients with stroke was compared with those in healthy control subjects using a computerized motor skill analyzer that calculated the accuracy in the tracking task in terms of lap time and trajectory error. Trajectory errors in the task by the unaffected lower limb in the patients with stroke were significantly greater than those in the lower limb of healthy control subjects. These results suggest that patients with stroke have impaired visuo-motor skills of the unaffected lower limb.
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Affiliation(s)
- Kazumi Kawahira
- Department of Rehabilitation and Physical Medicine Faculty of Medicine, Kagoshima University Kagoshima, Japan.
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