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PubMed1998

Neuropsychological changes after cardiopulmonary bypass for coronary artery bypass grafting.

BACKGROUND: An alarming incidence (1% to 83%) of neuropsychological dysfunction has been reported after operations using cardiopulmonary bypass (CPB). The present clinical study re-evaluates these complications with current CPB technology in a strictly selected low-risk group of coronary artery bypass (CABG) patients. METHODS: 76 CABG patients, without history of stroke or internal carotid artery stenosis, were examined before, 5 days after, and 2 months after surgery. A neuropsychological test battery was employed according to the "Statement of Consensus on Assessment of Neurobehavioral Outcomes after Cardiac Surgery". Tests include the Block Design Test (problem-solving strategies, recognition and analysis of forms), the Trail Making Test (cognitive achievement at speed), and the Digit Span Test (short-term memory and memory of figures). RESULTS: Both postoperative test scores were not significantly decreased as compared to preoperative values. In contrast, neuron specific enolase (NSE) and S100 b protein, biochemical markers of cerebral injury, increased markedly during and immediately after surgery (NSE preop.: 7.07 +/- 2.40 ng/ml, 1 h postop.: 13.64 +/- 4.50 ng/ml, p < 0.001; S100 b preop.: 0.04 +/- 0.07 ng/ml, after crossclamp: 0.90 +/- 0.69 ng/ml, p < 0.001). One patient displayed postoperative transitional syndrome, another patient suffered from transitory paresis and hypesthesia of the left arm, which disappeared during hospital stay. CONCLUSIONS: Biochemical markers demonstrate significant postoperative cerebral injury during and immediately after CPB. However, CPB for CABG does not lead to marked impairment of neuropsychological scores, and clinically relevant neurological findings were observed in one patient only.

Aged↗

PubMed2005

Is peri-operative cortisol secretion related to post-operative cognitive dysfunction?

BACKGROUND: The pattern of cortisol secretion is influenced by surgery. As cortisol can adversely affect neuronal function, this may be an important factor in the development of post-operative cognitive dysfunction (POCD). We hypothesized that the incidence of POCD would be related to changes in cortisol level. METHODS: We studied 187 patients aged over 60 years undergoing major non-cardiac surgery with general or regional anaesthesia. Saliva cortisol levels were measured pre-operatively and at 1 day, 7 days and 3 months post-operatively in the morning (08.00 h) and in the afternoon (16.00 h) using salivettes. Cognitive function was assessed pre-operatively, on day 7 and at 3 months using four neuropsychological tests. POCD was defined as a combined Z score of greater than 1.96. RESULTS: After surgery, salivary cortisol concentrations increased significantly. POCD was detected in 18.8% of subjects at 1 week and in 15.2% after 3 months. The pre-operative ratios between the morning and afternoon cortisol concentrations (am/pm ratios) were 2.8 and 2.7 in patients with POCD at 1 week vs. those without POCD at 1 week, respectively. The am/pm ratios decreased significantly post-operatively to 1.9 and 1.6 at 1 week, respectively (P = 0.02 for both). In an analysis considering all am/pm ratios, it was found that the persistent flattening in am/pm ratio was significantly related to POCD at 1 week. CONCLUSION: The pattern of diurnal variation in cortisol level was significantly related to POCD. Thus, circadian rhythm disturbance or metabolic endocrine stress could be an important mechanism in the development of cognitive dysfunction after major surgery.

Aged↗

PubMed1984

Influence of regional anaesthesia on postoperative morbidity.

A short review on the influence of regional anaesthesia on various parameters of postoperative morbidity is given. Only data from controlled studies have contributed to the conclusions. It appears that regional anaesthesia with local anaesthetics reduces intraoperative blood loss and postoperative thromboembolic complications after hip surgery and prostatectomy, while data from other procedures are inconclusive. Mortality is probably minimized by regional anaesthesia after acute hip surgery. No firm conclusion can be made with regard to the influence on postoperative cardial or pulmonary complications, mental dysfunction, infective complications, restoration of gastro-intestinal function as well as on convalescence, but several pieces of evidence from studies including only a limited number of patients suggest that regional anaesthesia may mitigate various aspects of postoperative morbidity. Future studies should be directed to give final answers on these points and furthermore consider the possible differing effect of a single dose infiltration anaesthesia or spinal anaesthesia versus continuous epidural analgesia, the optimal duration and extent of the neuronal block, and the effect of postoperative pain relief by epidural opiate administration.

Anesthesia, Conduction↗

PubMed2003

Quality of life and femoral neck fractures.

The worldwide increase in hip fractures is a major challenge to the health care system and society. The proper treatment of femoral neck fractures in the elderly is still controversial, and even more so from an international perspective. Optimising the treatment for improved outcomes and a reduced need for secondary surgery is mandatory for humanitarian and economical reasons. The importance of incorporating the patient's perspective of the outcome in clinical trials has been acknowledged and there are now numerous instruments for assessing the quality of life. We evaluated two quality of life instruments, the EQ-5D and the SF-36, in patients with femoral neck fractures and also measured the quality of life two years after different interventions. The EQ-5D was validated in two prospective studies and it appeared to be an appropriate quality of life instrument in elderly patients with femoral neck fractures. There was a good correlation between the quality of life (EQ-5Dindexscores) and other outcome measures such as pain, mobility and independence in activities of daily living (ADL). The results also showed high responsiveness, i.e., ability to capture clinically important changes, for both the EQ-5D and the SF-36. The questionnaire response rate for both instruments was high. The rated prefracture EQ-5Dindexscores showed good correspondence with the scores of an age-matched Swedish reference population. The quality of life in patients with femoral neck fractures treated with internal fixation (IF) decreased, particularly in patients with fracture healing complications. The fracture healing complications rate at two years in patients with displaced femoral neck fractures treated with IF was 36% compared with 7% in patients with undisplaced fractures. The quality of life of patients with uneventfully healed fractures at two year was lower in patients with primary displaced fractures than in patients with primary undisplaced fractures. In a prospective randomised trial, patients with displaced femoral neck fractures were randomised to IF or total hip replacement (THR). IF resulted in more complications than THR, 36% versus 4%, and necessitated more reoperations, 42% versus 4%. Hip function and quality of life (EQ-5D) were generally better in the THR group. In summary, THR yielded a better outcome than IF for an elderly, relatively healthy, lucid patient with a displaced femoral neck fracture. In a study of elderly women with femoral neck fractures, nearly half of the patients displayed signs of protein-energy malnutrition. Underweight was associated with muscle fatigue, cognitive dysfunction and a low quality of life (Nottingham Health Profile). In a prospective randomised trial, protein-rich liquid supplementation in combination with an anabolic steroid given for 6 months to lean elderly women after a femoral neck fracture was shown to positively affect lean body mass, ADL and quality of life (EQ-5D). Fracture healing complications had a negative impact on body weight, lean body mass and quality of life.

Aged↗

PubMed2006

Long-term neurodevelopmental outcome and exercise capacity after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy.

BACKGROUND: The purpose of this prospective study was to assess whether neurodevelopmental status and exercise capacity of children 5 to 10 years after corrective surgery for tetralogy of Fallot or ventricular septal defect in infancy was different compared with normal children and influenced by the preoperative condition of hypoxemia or cardiac insufficiency. METHODS: Forty unselected children, 20 with tetralogy of Fallot and hypoxemia and 20 with ventricular septal defect and cardiac insufficiency, operated on with combined deep hypothermic circulatory arrest and low flow cardiopulmonary bypass at a mean age of 0.7 +/- 0.3 years (mean +/- SD), underwent, at mean age 7.4 +/- 1.6 years, standardized evaluation of neurologic status, gross motor function, intelligence, academic achievement, language, and exercise capacity. Results were compared between the groups and related to preoperative, perioperative, and postoperative status and management. RESULTS: Rate of mild neurologic dysfunction was increased compared with normal children, but not different between the groups. Exercise capacity and socioeconomic status were not different compared with normal children and between the groups. Compared with the normal population, motor function, formal intelligence, academic achievement, and expressive and receptive language were significantly reduced (p < 0.01 to p < 0.001) in the whole group and in the subgroups, except for normal intelligence in ventricular septal defect patients. Motor dysfunction was significantly higher in the Fallot group compared with the ventricular septal defect group (p < 0.01) and correlated with neurologic dysfunction, lower intelligence, and reduced expressive language (p < 0.05 each). Reduced New York Heart Association functional class was correlated with lower exercise capacity and longer duration of cardiopulmonary bypass (p < 0.05 each). Reduced socioeconomic status significantly influenced dysfunction in formal intelligence (p < 0.01) and academic achievement (p < 0.05). Preoperative risk factors such as prenatal hypoxia, perinatal asphyxia, and preterm birth, factors of perioperative management such as cardiac arrest, lowest nasopharyngeal temperature, and age at surgery, and postoperative risk factors as postoperative cardiocirculatory insufficiency and duration of mechanical ventilation were not different between the groups and had no influence on outcome. Degree of hypoxemia in Fallot patients and degree of cardiac insufficiency in ventricular septal defect patients did not influence the outcome within the subgroups. CONCLUSIONS: Children with preoperative hypoxemia in infancy are at higher risk for motor dysfunction than children with cardiac insufficiency. Corrective surgery in infancy for tetralogy of Fallot or ventricular septal defect with combined circulatory arrest and low flow bypass is associated with reduced neurodevelopmental outcome, but not with reduced exercise capacity in childhood. In our experience, the general risk of long-term neurodevelopmental impairment is related to unfavorable effects of the global perioperative management. Socioeconomic status influences cognitive capabilities.

Child↗

PubMed1998

A test of spatial memory and its clinical utility in the pre-surgical investigation of temporal lobe epilepsy patients.

Deficits in memory for figurative detail, spatial composition and the spatial location of objects in a scene have been reported postoperatively in right temporal lobectomy patients. The aim of this study was to examine whether these deficits can be used as a sign of lateralised dysfunction in pre-surgical temporal lobe epilepsy (TLE) patients. Sixty-nine patients with lateralised TLE (27 right, 42 left) were assessed on a battery of neuropsychological tests, including tests of general intellectual functioning and psychomotor speed and standardised memory tests involving the learning and recall of verbal and non-verbal material. A new task, the "Aspects of Spatial Memory Test" (AoSMT), based on the experimental tasks developed by Pigott and Milner [39] was also administered. The RTLE and LTLE groups did not differ in their overall level of intellectual function or on measures of cognitive and motor speed. On the AoSMT the LTLE group recognised significantly more figurative detail changes than the RTLE group. In addition, the RTLE group took significantly longer than the LTLE group to identify changes in orientation, figurative detail and filled/unfilled spaces. Poor scores on the AoSMT were significantly correlated with quantitative MRI measures of right hippocampal pathology. The clinical and theoretical implications of these findings are discussed.

Adult↗

PubMed1999

Posttraumatic tension pneumocephalus.

This case presentation will review tension pneumocephalus as a rare etiology of delayed posttraumatic headache (PTHA). It demonstrates that clinicians must be aware of even the uncommon causes of PTHA if appropriate diagnostic assessment and treatment are to be rendered. The case involves a 26-year-old right-handed white male who was 4 years post severe traumatic brain injury with facial fractures and an initial Glasgow Coma Scale score of 5. The patient's main postinjury functional impairments were cognitive-behavioral dysfunction, dysmetria, left hemiparesis, and posttraumatic epilepsy. Approximately 3 years post injury, the patient started to have complaints of right unilateral frontal headache. This complaint was addressed conservatively by several treating physicians. Due to the progressive nature of the patient's complaints, a second opinion was obtained with the author. On assessment, the patient complained of unilateral right headache and described the pain as making him feel as if his head was going to "bust open." A computed tomography (CT) scan showed findings consistent with a tension pneumocephalus. The patient was referred to neurosurgery, at which time the tension pneumocephalus was evacuated and a dural leak, felt to be responsible for the condition, patched. The patient's headache complaints resolved postoperatively. Clinicians should be aware of uncommon conditions that may be present in patients presenting with late PTHA, particularly conditions such as tension pneumocephalus which may have a significant clinical morbidity.

Adult↗

PubMed1982

A clinical neuropsychological study of the postoperative course after three types of anaesthesia.

In a double-blind study, 57 patients were anaesthetized with either Althesin, thiopentone, or fentanyl combined with diazepam for cystoscopies. One and a half and four hours after the administration of anaesthesia, the patients were investigated with an objective neuropsychological method, continuous Reaction Time, and with a subjective rating scale. Beecher's Mood Scale. One week later the patients answered a questionnaire about side-effects experienced during the days following anaesthesia. At the 1 1/2 h investigation, the patients were cerebrally affected, both subjectively and objectively. The CNS-dysfunction was different for the three anaesthetics. After administration of thiopentone, the patients experienced the highest degree of subjective effects but had the smallest reaction time prolongation. Fentanyl-diazepam gave the least subjective effects, but the highest degree of cerebral affection in the reaction time measurements. The effects of Althesin were intermediate. Four hours after anaesthesia, the reaction time prolongations had disappeared, except for Althesin, and only patients who had thiopentone registered subjective effects. The number of side-effects was greatest and most prolonged following thiopentone. About 25% of the patients reported that side-effects had persisted more than 1 day after anaesthesia.

Adult↗

PubMedDate not supplied

Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood.

UNLABELLED: Traditionally, the cerebral hemispheres have been regarded as the region of the brain responsible for cognitive functions, while the cerebellum has been considered to be primarily involved in motor functions. Recent studies focus also on the possible involvement of the cerebellum in neurocognitive functions. The aim of this study was to determine the neuropsychological profile of young adults treated for a posterior fossa tumor in childhood and look for possible support for the presence of the so-called 'cerebellar cognitive affective syndrome' in these patients. Two groups of young adults were studied. The astrocytoma group (n = 12) had been treated for a low-grade cerebellar astrocytoma with surgery alone (mean age at surgery was 8.6 years and mean age at neuropsychological testing was 23.5 years). The medulloblastoma group (n = 11) had been treated with surgery followed by radiotherapy and chemotherapy (mean age at surgery was 6.1 years and mean age at neuropsychological testing was 23.1 years). The neuropsychological test battery comprised measures of intelligence, motor function, attention, psychomotor speed, verbal memory and visual memory. The medulloblastoma group performed poorer than the astocytoma group on all neuropsychological measures except one. Nonetheless, the astrocytoma group also had impaired scores compared with standard norms on measures of motor speed, attention and executive function. No significant correlation between age at time of treatment and grade of neuropsychological impairment was found in the astrocytoma group, though there was a tendency that young age at time of treatment correlated with better outcome on IQ measures. In the medulloblastoma group, age was significantly correlated with outcome, for both IQ and degree of neuropsychological impairment. For this group, young age at time of treatment indicated a worse outcome. CONCLUSIONS: Persistent cognitive dysfunction was detected in patients treated for posterior fossa medulloblastoma and cerebellar astrocytoma. The astrocytoma group was treated with surgery alone, indicating that a cerebellar lesion can result in cognitive dysfunction. Thus, this study gives support to the existence of the cerebellar cognitive affective syndrome. Follow-up of all patients treated for posterior fossa tumor in childhood should include an extensive neuropsychological testing at regular intervals. This may be of benefit for school planning and later work planning.

Adolescent↗

PubMed2003

Chronic exposure to nicotine does not prevent neurocognitive decline after cardiac surgery.

OBJECTIVE: To establish the association between smoking and cognitive decline in patients undergoing coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective review. SETTING: Referral center for cardiothoracic surgery at a university hospital. PARTICIPANTS: Four hundred seventeen patients undergoing CABG surgery. INTERVENTIONS: Based on preoperative data, patients were divided into 2 groups: smokers (n = 185) and nonsmokers (n = 232). Patients who smoked half a pack of cigarettes per day within the last 2 years were identified as smokers, and patients who did not smoke were included in the nonsmoker group. Patients with less than a seventh grade education; an inability to read; or a history of one of the following medical conditions: prior stroke with residual deficit, psychiatric illness, renal disease (creatinine > 2.0 mg/dL), or active liver disease; or patients who quit smoking prior to surgery were excluded from the study. Both groups received similar anesthetic and surgical management. All patients received a battery of neurocognitive tests both preoperatively and 6 weeks after CABG surgery. Neurocognitive test scores were separated into 4 cognitive domains, with a composite cognitive index (the mean of the four domain scores) determined for each patient at every testing period. MEASUREMENTS AND MAIN RESULTS: The overall rate of cognitive decline at 6 weeks after surgery in smokers was 36.2%, whereas nonsmokers showed a deficit rate of 36.6%. Nonsmokers were significantly older and presented for surgery on average 6 years later than the smokers. Female sex represented a considerably larger proportion of patients in the nonsmoker group. Smokers had a higher prevalence of myocardial infarction. The univariate analysis of cognitive change at 6 weeks adjusted for age, baseline cognitive index, and education years showed no difference between the 2 groups. Sex, history of myocardial infarction, hypertension, stroke, transient ischemic attack, and duration of cardiopulmonary bypass did not contribute to the multivariate logistic regression model and were dropped from the final analysis. Significant multivariate predictors of neurocognitive dysfunction included age, left ventricular ejection fraction, baseline education level, and baseline cognitive index. CONCLUSIONS: This study confirmed previous findings that age, baseline cognitive function, years of education, and impaired left ventricular function are independent predictors of neurocognitive decline at 6 weeks after CABG surgery. Smoking is neither preventive nor causative of cognitive decline after CABG surgery.

Aged↗

PubMed2006

Shift-back of right into left hemisphere language dominance after control of epileptic seizures: evidence for epilepsy driven functional cerebral organization.

Atypical, i.e. right hemisphere language dominance is frequently observed in early onset left hemisphere epilepsies. In left mesial temporal lobe epilepsy, where eloquent cortex is not directly involved, it is a matter of debate, to which degree atypical language dominance is driven not only by morphological lesions but also by epileptic dysfunction, and whether atypical dominance is hardwired or not. Taking this as the background this study evaluated the hypothesis that epilepsy driven atypical dominancy might be reversible when seizures are successfully controlled. This was evaluated in patients with left mesial temporal lobe epilepsy, who were atypically language dominant by means of language fMRI before surgery, and became seizure free after left selective amygdalo-hippocampectomy. Three out of 53 consecutive atypically dominant patients with chronic epilepsy fulfilled these criteria. Postoperative follow-up language fMRI indicated reversal of right into left dominance in one patient going along with unexpected losses in verbal memory performance. The two other patients experienced unchanged or even enhancement of the pre-existing dominance pattern, going along with consistent postoperative performance changes in cognition. The data thus provide supporting evidence that atypical language dominance can indeed be functionally driven and moreover that in at least some patients, right hemispheric language can shift-back to the left hemisphere when the driving factor, i.e. seizures, becomes successfully controlled. The results have clinical implications for outcome prediction after brain surgery in atypically dominant patients with epilepsy. However, further research in larger groups of atypically dominant patients is required to identify the conditions under which atypical dominance becomes hardwired and when not.

Adult↗

PubMed1999

Mood disorders in patients after treatment for primary intracranial tumours.

The frequency of mood disorder was studied in a cohort of patients with treated intracranial glioma or meningioma, where psychological morbidity was related to physical and neuropsychological functioning and to the patients' knowledge of their disease. Forty patients were assessed on a range of physical, psychological and neuropsychological measures, with additional interview of a relative to obtain supplementary information regarding each patients' knowledge of their disease. Two (5%) of the 40 patients had clinically significant levels of anxiety, six (15%) clinically significant levels of depression and 92% full or intermediate knowledge about their prognosis. Psychological morbidity was associated with high levels of physical disability and also with cognitive dysfunction, but was not related to the grade of the patient's tumour or the extent to which the patient was aware of the nature of his or her disease. A proportion of patients with intracranial tumours suffer levels of psychological distress sufficient to warrant psychological and/or pharmacological intervention.

Adolescent↗

PubMed2004

Statistical and conceptual issues in defining post-operative cognitive dysfunction.

The occurrence of post-operative cognitive dysfunction is a distressing complication following surgery. In an effort to gain a more complete understanding of patients' cognitive recovery following surgical procedures common neuropsychological assessment tools have been adopted in a repeated measures design. It is widely regarded that this represents the most comprehensive method of determining cognitive status in this population but it has resulted in a number of statistical and conceptual difficulties in attempting to infer significant change. The current paper outlines these core difficulties and provides some potential methods to overcome these.

Cognition Disorders↗

PubMedDate not supplied

[Cognitive development of children and adolescents after correction of transposition of great vessels].

BACKGROUND: To study the effect of transposition of the great arteries on later cognitive functioning. PATIENTS: Twentyeight children and adolescents underwent psychometric testing 3.5 to 13.7 years following operation. METHODS: A battery of intelligence, attention and visual memory tasks as well as the Draw-a-Man-Test were administered. Parents completed standardized questionnaires on developmental milestones. RESULTS: Both, mean verbal (93 +/- 15) and performance IQs (97 +/- 21) were normal. The length of interval between operation and psychologic test but not age at repair was a significant predictor of intelligence quotient. Half of the children (9/18) showed attention deficits, 7/11 (64%) were identified as suspect of brain dysfunction. Performance on the Draw-a-Man-Test disclosed 12 (43%) as slightly mentally retarded. CONCLUSIONS: (1) Cognitive functions in children with TGA are more impaired than suggested by the results of intelligence tests. (2) Psychological and neurologic follow-up should be mandatory from early on. (3) Previous studies have overestimated children's intelligence due to unrecognized changes of test norms.

Adolescent↗

PubMed2006

Executive performance on the Wisconsin Card Sorting Test in mesial temporal lobe epilepsy.

Executive dysfunction assessed by the Wisconsin Card Sorting Test has been observed in patients with mesial temporal lobe epilepsy (TLE); however, the mechanism of executive impairment is unclear. We therefore investigated the potential contribution of the hippocampus toward executive dysfunction in 85 mesial TLE patients, and in a control group of 34 patients with neocortical TLE. Standardized regression-based methodology was used for correcting test-retest bias. We found that 56% of mesial TLE patients had impaired sorting performance, with 30% showing severe impairment. A lower full-scale intelligence quotient, older age, longer duration, and preoperative use of topiramate were significantly correlated with poorer preoperative sorting abilities. However, neither these variables nor postoperative discontinuation/reduction of topiramate were related to postoperative changes in sorting abilities. Only preoperative sorting abilities were negatively correlated with postoperative changes in executive performance. That is, patients with better preoperative executive ability showed greater postoperative deterioration in executive function, whereas those with poorer preoperative sorting ability had greater improvement in executive function after mesial temporal resection. There were no differences in card sorting ability between the mesial and neocortical TLE groups. In conclusion, our results suggest that impairment of card sorting performance in the mesial TLE group cannot be explained only by hippocampal dysfunction, but that other processes (possibly epileptic discharges propagated to the extratemporal area) must play a predominant role.

Adult↗

PubMed2006

Mood and behavioral dysfunction with opsoclonus-myoclonus ataxia.

Opsoclonus-myoclonus ataxia syndrome is a paraneoplastic syndrome of cerebellar damage associated with neuroblastoma. The authors assessed psychiatric symptoms of opsoclonus-myoclonus ataxia syndrome in 17 children, who were 16 months to 12(1/2) years of age. Psychiatric symptoms examined included disruptive behavior, affective dysregulation, irritability, impulsivity, cognitive impairment, and poor attention.

Cerebellar Ataxia↗

PubMed1995

Low-grade gliomas of the cerebral hemispheres in children: an analysis of 71 cases.

Low-grade gliomas constitute the largest group of cerebral hemispheric tumors in the pediatric population. Although complete tumor resection is generally the goal in the management of these lesions, this can prove difficult to achieve because tumor margins may blend into the surrounding brain. This raises several important questions on the long-term behavior of the residual tumor and the role of adjuvant therapy in the management of these lesions. To examine these issues, the authors reviewed their experience in 71 children with low-grade cerebral hemispheric gliomas who were treated at their institution between 1956 and 1991 and assessed the relationship between clinical, radiographic, pathological, and treatment-related factors and outcome. Only seven patients in the series died, one from perioperative complications, five from progressive disease, and one (a child with neurofibromatosis) from a second neoplasm. For the 70 patients who survived the perioperative period, overall actuarial survivals at 5, 10, and 20 years were 95%, 93%, and 85%, respectively; progression-free status was maintained in 88%, 79%, and 76%, respectively. On univariate analysis, the factor that was most strongly associated with both overall and progression-free survival was the extent of tumor resection (p = 0.013 and p = 0.015, respectively). A relationship between extent of resection and progression-free survival was present both in patients with pilocytic astrocytomas (p = 0.041) and those with nonpilocytic tumors (p = 0.037). Histopathological diagnosis was also associated with overall survival on univariate analysis; poorer results were seen in the patients with nonpilocytic astrocytoma compared to those with other low-grade gliomas, such as pilocytic astrocytoma, mixed glioma, and oligodendroglioma (p = 0.021). The use of radiotherapy was not associated with a significant improvement in overall survival (p = 0.6). All three patients who ultimately developed histologically confirmed anaplastic changes in the vicinity of the original tumor had received prior radiotherapy, 20, 46, and 137 months, respectively, before the detection of malignant progression. In addition, children who received radiotherapy had a significantly higher incidence of late cognitive and endocrine dysfunction than the nonirradiated patients (p < 0.01 and 0.05, respectively). The authors conclude that children with low-grade gliomas of the cerebral hemispheres have an excellent overall prognosis. Complete tumor resection provides the best opportunity for long-term progression-free survival. However, even with incomplete tumor excision, long-term progression-free survival is common.(ABSTRACT TRUNCATED AT 400 WORDS)

Actuarial Analysis↗

PubMed1996

[Preservation of procedural memory in 18 patients operated for aneurysm of the anterior communicating artery].

Organic amnesia is typically associated with lesions in either the diencephalic or medial temporal regions of the brain. However, amnesia can result from other kinds of lesions, in particular those resulting from an aneurysm of the anterior communicating artery (ACoA). In the present study, 7 patients who became amnesic following a ruptured and operated ACoA aneurysm were comparated neuropsychologically with 11 patients with ruptures but no cognitive complaints and 18 normal control subjects. They were submitted to explicit and implicit memory tests and to tests claimed to be sensitive to frontal lobe dysfunction. The performance of the 11 ACoa patients without cognitive complaints revealed evidence for a functional frontal dysfunction (test of Stroop) and a partial deficit of explicit memory (free recall and long-term recall). The performance of the 7 ACoa amnesics revealed evidence for a functional frontal dysfunction and a deficit of explicit memory (safe in recognition). Anosognosia was also observed. The performance of all patients revealed the preservation of implicit memory in procedural tasks (serial reaction time and mirror reading) as diencephalic and temporal amnesia. The functionnal nature of the syndrome is discussed.

Adult↗