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. 2025 Jan;32(1):e16492.
doi: 10.1111/ene.16492. Epub 2024 Oct 30.

Long-term cognitive outcomes after decompressive hemicraniectomy for right-hemisphere large middle cerebral artery ischemic stroke

Giuseppe Scopelliti  1   2 , Hilde Henon  1 , Olivier Masheka-Cishesa  1   3 , Julien Labreuche  4 , Gregory Kuchcinski  5 , Rabih Aboukais  6 , Charlotte Cordonnier  1 , Barbara Casolla  7
Affiliations

Long-term cognitive outcomes after decompressive hemicraniectomy for right-hemisphere large middle cerebral artery ischemic stroke

Giuseppe Scopelliti et al. Eur J Neurol. 2025 Jan.

Abstract

Background and purpose: Decompressive hemicraniectomy (DH) improves survival and functional outcome in large middle cerebral artery (MCA) infarcts. However, long-term cognitive outcomes after DH remain underexplored. In a cohort of patients with large right-hemisphere MCA infarction undergoing DH, we assessed the rates of long-term cognitive impairment over 3-year follow-up.

Methods: We prospectively evaluated consecutive patients included in the Lille Decompressive Surgery Database (May 2005-April 2022) undergoing DH according to existing guidelines for large hemisphere MCA infarction. We included patients with right-sided stroke and screened with the Mini-Mental State Examination (MMSE) in at least one of the prespecified follow-ups (3-month, 1-year, 3-year). Cognitive impairment was defined as an MMSE score < 24. We included only right-hemisphere strokes to avoid testing biases related to severe aphasia. We compared clinical and neuroimaging data in patients with and without cognitive impairment.

Results: Three hundred four patients underwent DH during the study period. Among 3-month survivors, 95 had a right-hemisphere stroke and underwent at least one cognitive screening (median age = 51 years, 56.8% men). Forty-four patients (46.3%) exhibited cognitive impairment at least once during the 3-year follow-up. Baseline characteristics did not significantly differ between patients with and without cognitive impairment. Regarding long-term temporal trends, cognitive impairment was observed in 23 of 76 (30.3%), 25 of 80 (31.3%), and 19 of 66 (28.8%) patients at 3-month, 1-year, and 3-year follow-up, respectively, and it was associated with higher rates of functional disability (all p < 0.05).

Conclusions: The persistently high rates of cognitive impairment after DH highlight the importance of cognitive monitoring to improve the long-term management of survivors.

Keywords: cognitive impairment; decompressive hemicraniectomy; ischemic stroke.

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Conflict of interest statement

C.C. has received fees for advisory boards (Bayer, Biogen, Novartis) and speaker fees (Amgen). B.C. has received speaker fees (Amgen, Sanofi‐Aventis France, Acticor Biotech).

Figures

FIGURE 1
FIGURE 1
Flowchart of patient inclusion.
FIGURE 2
FIGURE 2
Rates of cognitive impairment during long‐term follow‐up.
FIGURE 3
FIGURE 3
Trajectories of patients with cognitive impairment across the three timepoints. This graph shows the 51 patients who underwent cognitive screening at all three timepoints. MMSE, Mini‐Mental State Examination. Made with SankeyMATIC.
See this image and copyright information in PMC

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