Short-Term Memory Impairment and Left Dorsolateral Prefrontal Cortex Dysfunction in the Orthostatic Position: A Single Case Study of Sinking Skin Flap Syndrome

Sebastianelli, Luca; Stoll, Verena; Versace, Viviana; Martignago, Sara; Obletter, Stephan; Lavoriero, Marco; Malfertheiner, Kathrin; Gisser, Gertraud; Saltuari, Leopold

doi:10.1155/2015/318917

Cited by 2 publications

(2 citation statements)

References 20 publications

(20 reference statements)

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“…[ 16 ] Subsequently, Sebastianelli et al (2015) reported on a stroke patient who revealed restoration of hypoperfusion of the DLPFC on electroencephalography concurrent with a reduction of cognitive impairment following C/P. [ 17 ] In 2018, Jiang et al demonstrated improvements to cerebral blood flow to and cerebral blood volume of the frontal lobe after C/P in patients with TBI. [ 18 ] In 2019, Panwar et al demonstrated improvement of cerebral blood flow of the OFC on CT perfusion in patients with TBI who showed improved cognitive function after C/P.…”

Section: Discussionmentioning

confidence: 99%

Changes in the prefronto-thalamic tract following cranioplasty

2021

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Rationale: The prefrontothalamic tract (PTT) injury is associated with various neuropsychological impairments including cognitive impairment. We report on three women with hemorrhagic stroke who showed changes in the PTT following cranioplasty (C/P) using diffusion tensor tractography (DTT) images. Patient concerns: The 3 women with hemorrhagic stroke showed reductions of cognitive impairment following C/P. Mini-Mental State Examination scores (MMSE) were increased by 7-, 8-, and 5-point in patient 1, 2, and 3, respectively, after C/P compared with the patients’ pre-C/P MMSE scores. Diagnosis: Three patients were diagnosed with spontaneous intracerebral hemorrhage. Three patients underwent C/P using auto-bone at 7 (patient 1 and 3) and 13 (patient 2) weeks after onset. Interventions: Diffusion tensor imaging data were acquired within 3 days before and 21 days after C/P. Outcomes: The pre-C/P DTT results showed non-reconstruction of the dorsolateral prefrontal cortex (DLPFC; patient 2 and 3) on the contralateral operation (contra-OP) side and orbitofrontal cortex (OFC; patient 3) on both sides, but those were reconstructed on post-C/P DTT. Except for the contra-OP side OFC of patient 2, all fractional anisotropy values decreased on post-C/P DTT compared with pre-C/P DTT. The mean diffusivity values of the VLPFC and OFC were higher on post-C/P DTT except for the contra-OP side VLPFC of patient 1 and contra-OP side OFC of patient 2. The voxel numbers also increased except for the contra-OP side VLPFC of patient 1. Lessons: We demonstrated structural changes in the PTT along with concomitant reductions of cognitive impairments following C/P in 3 women with hemorrhagic stroke using DTT. The DTT changes suggest that C/P can affect the state of the PTT on both the OP and contra-OP sides. However, the limitation that DTT analysis may underestimate or overestimate fiber tract status due to regions of fiber complexity and crossing fiber should be considered.

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Section: Discussionmentioning

confidence: 99%

Changes in the prefronto-thalamic tract following cranioplasty

2021

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“…The paradoxical herniation is a rare but life-threatening complication of cerebrospinal fluid (CSF) drainage in patients with large decompressive craniectomies. This result is due to a combined effect of brain gravity, atmospheric pressure, and intracranial hypotension[ 1 , 2 ]. Paradoxical herniation has been reported after craniotomy in the context of CSF hypovolemia, usually ascribed to intraoperative or postoperative CSF drainage or spinal CSF fistula[ 1 , 3 - 5 ].…”

Section: Introductionmentioning

confidence: 99%

Paradoxical herniation after decompressive craniectomy provoked by mannitol: A case report

Du¹,

Tang²,

Fan³

2022

WJCC

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BACKGROUND Paradoxical transtentorial herniation is a rare but life-threatening complication of cerebrospinal fluid drainage in patients with large decompressive craniectomy. However, paradoxical transtentorial herniation after rapid intravenous infusion of mannitol has not been reported yet. CASE SUMMARY A 48-year-old male suffered from a right temporal vascular malformation with hemorrhage. In a coma, the patient was given emergency vascular malformation resection, hematoma removal, and the right decompressive craniectomy. The patient woke up on the 1st d after the operation and was given 50 g of 20% mannitol intravenously every 8 h without cerebrospinal fluid drainage. On the morning of the 7th postoperative day, after 50 g of 20% mannitol infusion in the Fowler’s position, the neurological function of the patient continued to deteriorate, and the right pupils dilated to 4 mm and the left to 2 mm. Additionally, computed tomography revealed an increasing midline shift and transtentorial herniation. The patient was placed in a supine position and given 0.9% saline intravenously. A few hours later, the patient was fully awake with purposeful movements on his right side and normal communication. CONCLUSION Paradoxical herniation may occur, although rarely, after infusing high-dose mannitol intravenously in the Fowler’s position in the case of a large craniectomy defect. An attempt should be made to place the patient in the supine position because this simple maneuver may be life-saving. Do not use high-dose mannitol when the flap is severely sunken.

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Short-Term Memory Impairment and Left Dorsolateral Prefrontal Cortex Dysfunction in the Orthostatic Position: A Single Case Study of Sinking Skin Flap Syndrome

Cited by 2 publications

References 20 publications

Changes in the prefronto-thalamic tract following cranioplasty

Changes in the prefronto-thalamic tract following cranioplasty

Paradoxical herniation after decompressive craniectomy provoked by mannitol: A case report

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