The complex character of the cognitive repercussions of stroke can be better harnessed by employing modern neuropsychological assessment procedures. This allows both a detailed categorization of the patients for the selection and effectiveness of therapeutic intervention, as well as the construction of reliable prognostic models.

Background and Purpose-Many patients who survive an aneurysmal subarachnoid hemorrhage experience decreased health-related quality of life (HRQoL). Physical factors have been identified as determinants of HRQoL. We describe long-term HRQoL and assessed whether psychological symptoms and personality characteristics determine HRQoL after subarachnoid hemorrhage. Methods-In a cross-sectional study in 141 patients living independently in the community 2 to 4 years after subarachnoid hemorrhage, we assessed whether HRQoL, evaluated by the Stroke Specific Quality of Life scale, was related to psychological symptoms (mood disorders, fatigue, and cognitive complaints), personality characteristics (neuroticism and passive coping style), demographic characteristics, and subarachnoid hemorrhage disease characteristics. Results-Best Stroke Specific Quality of Life scale scores were found in the physical domain and worst in the emotional and social domains. Thirty-two percent reported anxiety, 23% depression, and 67% fatigue. Mood (beta between Ϫ0.42 and Ϫ0.18), fatigue (beta between Ϫ0.40 and Ϫ0.24), and cognitive complaints (beta between Ϫ0.46 and Ϫ0.16) were strongly associated with Stroke Specific Quality of Life scale scores in multivariate regression analyses. Conclusion-Depression, anxiety, and fatigue were present in a substantial proportion of patients and were strongly related to decreased HRQoL. These symptoms identified are helpful to tailor rehabilitation to the needs of patients in the chronic phase after subarachnoid hemorrhage.

CJ, Engstrom BI, et al. J Vasc Interv Radiol 2012;23: 69-74 Conclusion: Covered stent exclusion of intragraft dialysis access graft pseudoaneurysms is correlated with a high rate of eventual graft infection.Summary: Prosthetic arteriovenous (AV) grafts are prone to develop pseudoaneurysms that are thought related to graft material degeneration secondary to repeated cannulation at specific sites. Such pseudoaneurysms may be particularly prone to develop infection in the face of outflow obstruction. Endovascular treatment can be used to treat prosthetic AV graft pseudoaneurysms with reports of high technical success and acceptable patency rates (Vesely TM, J Vasc Interv Radiol 2005;16:1301-7; Najibi S et al, J Surg Res 2002;106:15-19). However, the authors of this report indicated an anecdotal impression that incorporating this technique into their practice resulted in a higher incidence of prosthetic AV graft infection. They therefore sought to study whether stent graft treatment of prosthetic AV graft pseudoaneurysms influenced the incidence of AV graft infection. The authors reviewed their interventional radiology database for prosthetic AV graft interventions involving stent deployment anywhere within the AV graft and found 235 interventions in 174 patients between November 2004 and December 2008. The incidence of AV graft infection was analyzed by stent type (bare metal vs covered), location, and indication for stent deployment on a per-stent, per-procedure, and per-graft basis. Eventually, 16.3% of AV grafts with stents implanted required surgical excision for graft infection. When covered stents were used to treat intragraft pseudoaneurysms, the subsequent rate of graft infection increased compared with bare-metal stents or covered stents deployed within the graft for other reasons (42.1% vs 18.2%, P ϭ .011). When stents were deployed at an intragraft location, there was a higher incidence of graft infection compared with those deployed at a venous anastomosis or in an outflow vein (26.9% vs 6.9%, P Ͻ .001).Comment: Pseudoaneurysms of prosthetic dialysis grafts are usually associated with a history of repeated punctures at the site where the pseudoaneurysm developed. More punctures in a specific site will likely increase the risk of contamination, and the more the risk of contamination the more the risk of infection. It follows, as shown here, that placing an additional prosthetic under such circumstances is not likely to have favorable outcomes. Cognition After Carotid Endarterectomy or Stenting: A Randomized ComparisonAltinbas A, van Zandvoort MJ, van den Berg E, et al. Neurology 2011;77: 1084-90.

BackgroundUntil 2015, Dutch guidelines recommended follow-up and biopsy rather than surgery as initial care for suspected low-grade gliomas (LGG). Given evidence that surgery could extend patient survival, our center stopped following this guideline on January 1, 2010 and opted for early maximal safe resection of LGG. The effects of early surgery on the ability of patients to work remains little documented.MethodsA total of 104 patients operated on at our center between January 2000 and April 2013 and diagnosed with the WHO 2016 grade 2 astrocytoma, IDH mutant or oligodendroglioma, IDH mutant and deleted 1p19q were included. The clinical characteristics, survival, and work history of patients operated on before or after January 2010 were obtained from the patients’ records and compared. The minimal follow-up was 8 years.ResultsAs per policy change, the interval between radiological diagnosis and first surgery decreased significantly after 2010. Likewise, before 2010, 25.8% of tumors were initially biopsied, 51.6% were resected under anesthesia, and 22.5% under awake conditions versus 14.3%, 23.8%, and 61.9% after this date (p < 0.001). The severity of permanent postoperative neurological deficits decreased after 2010. In total, 82.5% of the patients returned to work postoperatively before 2010 versus 100% after 2010. The postoperative control of epilepsy increased significantly after 2010 (74.4% vs. 47.9%). The median time from diagnosis to a definitive incapacity to work increased by more than 2 years after 2010 (88.7 vs. 62.2 months).ConclusionA policy shift towards early aggressive surgical treatment of IDH mutant LGG is safe and prolongs the patients’ ability to work.