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Background and Purpose-The space-occupying effect of cerebral edema limits survival chances of patients with severe ischemic stroke. Besides conventional therapies to reduce intracranial pressure, hemicraniectomy can be considered as a therapeutic option after space-occupying cerebral infarction. There is controversy regarding the use of this method in patients with infarction of the speech-dominant hemisphere. Methods-In 14 patients with infarction of the dominant hemisphere and subsequent treatment with hemicraniectomy, recovery from aphasic symptoms was evaluated retrospectively. A group of patients who were treated between 1994 and 2003 in our aphasia ward was selected for the study. In all patients, a psychometric quantification was accomplished applying the Aachen Aphasia Test at least twice within a mean observation period of 470 days. Results-A significant improvement of the statistical parameters representing different aspects of aphasia was observed in 13 of 14 patients. Also, an increase of the ability to communicate was evident in 13 patients. Young age at the time of stroke and early poststroke decompressive surgery were identified as main predictors for recovery from aphasia. Conclusions-A significant improvement of aphasic symptoms can be observed in a preselected group of patients after a massive stroke of the speech-dominant hemisphere treated by consecutive hemicraniectomy. Therefore, decompressive surgery can be considered for the treatment of this kind of stroke. Key Words: aphasia Ⅲ cerebral infarction Ⅲ craniotomy Ⅲ recovery of function T he majority of stroke patients with space-occupying supratentorial infarctions have a fatal outcome. Conservative therapy of brain edema and consecutive transtentorial brain herniation is confined to hyperventilation, osmotherapy, barbiturate, and tris(hydroxymethyl)aminomethan buffer infusions. Despite this treatment, mortality of patients is up to 80%. 1 Frequently, removal of a bone flap and opening of the dura to relieve pressure and prevent transtentorial and uncal herniation can be appropriate life-saving procedures. This technique was first applied in 1905, 2 and since 1950, it was more frequently reported in the context of therapy of spaceoccupying infarction. Besides the improvement of cerebral perfusion, hemicraniectomy protects against herniation and may lower the mortality of stroke patients. Recent studies have shown that decompressive hemicraniectomy can decrease mortality to 21% to 35%. 3-5 After hemicraniectomy, the Barthel Index was reported to vary from 56% to 65% in unselected patients with middle cerebral artery territory stroke. 3,5,6 Clinical observations suggest that the long-term quality of life and the functional outcome of rehabilitation in surviving patients may significantly improve after hemicraniectomy. Presently, to our knowledge there is no existing randomized prospective trial of patients with spaceoccupying infarctions in evaluation of functional outcome.A series of factors is likely to affect long-term functional outcome ...

Neurofunctional alterations in acute posttraumatic stress disorder (PTSD) and changes thereof during the course of the disease are not well investigated. We used functional magnetic resonance imaging to assess the functional neuroanatomy of emotional memory in surgical patients with acute PTSD. Traumatic (relative to non-traumatic) memories increased neural activity in the amygdala, hippocampus, lateral temporal, retrosplenial, and anterior cingulate cortices. These regions are all implicated in memory and emotion. A comparison of findings with data on chronic PTSD suggests that brain circuits affected by the acute disorder are extended and unstable while chronic disease is characterized by circumscribed and stable neurofunctional abnormalities.

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Rotational atherectomy of ISR leads to acute lumen gain by effective plaque removal. Adjunct angioplasty results in additional lumen gain by further stent expansion and tissue extrusion. Stent and lesion length, severity of ISR and acute neointimal recoil are predictors of recurrent restenosis.

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