gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Cognitive plasticity after spontaneous intracranial hemorrhages

Meeting Abstract

  • Thomas Kapapa - Neurochirurgische Klinik, Universitätsklinikum Ulm, Deutschland
  • Christine Brand - Neurochirurgische Klinik, Universitätsklinikum Ulm, Deutschland
  • Annette Oechsner - Neurochirurgische Klinik, Universitätsklinikum Ulm, Deutschland
  • Bernd Schmitz - Sektion Neuroradiologie, Klinik für diagnostische und interventionellen Radiologie, Universitätsklinikum Ulm, Deutschland
  • Hayrettin Tumani - Neurologische Klinik, Universitätsklinikum Ulm, Deutschland
  • Anna-Katharina Fladung - Klinische Psychologie und Psychotherapie, Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm, Deutschland
  • Burkhard Alber - Neurologische Klinik, Bezirkskrankenhaus Günzburg, Deutschland
  • Christian Heinen - Neurochirurgische Klinik, Universitätsklinikum Ulm, Deutschland
  • Ralph König - Neurochirurgische Klinik, Universitätsklinikum Ulm, Deutschland
  • Eckhard Rickels - Klinik für Neurotraumatologie, Allgemeines Krankenhaus Celle, Deutschland
  • Dieter Woischneck - Neurochirurgische Klinik, Klinikum Landshut, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1828

DOI: 10.3205/10dgnc299, URN: urn:nbn:de:0183-10dgnc2998

Published: September 16, 2010

© 2010 Kapapa et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

Objective: Knowledge about the “acute exogene reactiontypus”, first described by Bonhoeffer 1908, seemed to be lost. This is reflected by marginal wisdom about cognitive processes after neurosurgical relevant intracranial hemorrhages in recent time. The relevance lies in the sophisticated transfer from acute medical treatment into the familiar surroundings. Cognition after neurosurgical treatment is a criteria to estimate outcome. The cognitive capacity after subarachnoid hemorrhage, intracerebral hemorrhage and chronic subdural hematoma is evaluated.

Methods: 71 patients with subarachnoid hemorrhage (PSAB, N=41), intracerebral hemorrhage (PICB, N=15) and chronic subdural hematoma (PSDH, N=15) from a period between 2007 and 2010 are explored neuropsychologically after 6 (t1) and 12 (t2) months after bleeding. Battery of test, consuming 3 to 4 hours, is assessing: attention, concentration, accuracy, speed, logical thinking, practically-constructive abilities, speech, judging, memory, association, space-constructive abilities, verbal learning, short-time visual memory, information-converting-speed, cognitive flexibility. Statistical calculations and comparison of groups are done by t-test with significance at p≤0.05.

Results: Mean age is 48 years for PSAB, 55 years for PICB and 54 years for PSDH. Mean intelligence quotient was 91–100 for PSAB, 81–90 for PICB and 100 for PSDH. Patients are mainly in very good and good outcome categories according to the Glasgow-Outcome-Scale. 1. All results at t1 are impaired and beneath the norm. Major impairments are with concentration and speed (PSDH) (p=0,0001). 2. The impairments (t1) are uniformly in all patient groups (PSAB-PICB-PSDH) except few tests. 3. All test-results show an improvement at t2 (p=0.0001 to 0.048). Exceptions are accuracy (PICB-PSDH), logical thinking (PSAB-PICB-PSDH), practically-constructive abilities (PICB-PSDH), and visual memory (PSAB-PICB-PSDH). In these there an ongoing impairment is to observe.

Conclusions: The pathphysiology of intracranial hemorrhages is minor influencing the characteristics of cognitive deficits or their plasticity according to mentioned assumptions. Cognitive rehabilitation makes sense in patients with chronic subdural hematomas. Their cognitive deficits correspond to patients with intracereral hemorrhages or subarachnoid hemorrhages. Training of cognitive abilities should emphasise on logical thinking even after 6 months. Disturbances of so called short-time memory could not be detected.