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Objective. Decompressive craniectomy is often emergently performed in an effort to reduce intracranial hypertension. After this urgent intervention, brain-injured patients often start rehabilitation programs but are left with a skull defect. Cranioplasty is often performed in these situations in order to repair this defect, mainly for cosmetic reasons and/or the patient's safety. The possible effects of this breach on the patients' neurological recovery are poorly understood and have been scarcely evaluated until now. The effect of cranioplasty on cognitive and motor functions in severely brain-injured individuals remains controversial. Methods and procedures. In order to further support evidence of the beneficial effects of cranioplasty on motor and cognitive function in severely brain-injured individuals, we discuss four cases, retrospectively selected among a cohort of several patients who underwent decompressive craniectomy after severe brain injury. The selected patients presented a biphasic pattern of recovery of cognitive and motor performance consisting of an initial improvement, followed by a progressive worsening of neurological signs and symptoms, and, ultimately, an unexpected recovery of function following cranioplasty. Main outcomes and results. In all four cases, we found a deterioration of motor and neuropsychological deficits prior to cranioplasty and a subsequent unexpected improvement in performance on a neuropsychological battery and a series of motor function tests immediately after cranioplasty. Conclusions. Results give clear evidence that a subset of patients are negatively affected by the persistence of a breach in skull integrity during the rehabilitation phase of brain injury. Moreover, they show that the repair of the cranial defect can trigger relevant neurological improvement in both motor and cognitive domains. This possibility should serve as a reminder to rehabilitation clinicians to give serious consideration to prompt performance of cranioplasty during the time allotted for the rehabilitation of these patients. [ABSTRACT FROM AUTHOR]

This study tested the association between cognitive functions, cerebrovascular damage, and cerebrovascular reactivity in 71 essential young hypertensives (age matched) and 22 normotensives (age matched). They underwent ambulatory blood pressure monitoring, neurocognitive tests, cerebral magnetic resonance, and transcranial Doppler. Twenty-three percent of patients showed more than 10 white matter lesions and 8% showed none. No control subjects showed more than 10 white matter lesions and 90% of normal controls showed no lesions. Patients with more than 10 white matter alterations had longer hypertensive story and showed significant lower nocturnal blood pressure fall. Pulsatility index was correlated with the number of white matter lesions. [ABSTRACT FROM AUTHOR]

Primary objective: Even in non-communicative disorders of consciousness such as vegetative and minimally conscious states, increasing the personal relevance and complexity of stimuli appears to enhance their activating effect in patients. It was hypothesized that enriched stimulation in an immersive environment could increase the number and/or the goal-directed quality of active movements. Methods, research design and procedures: Twelve patients with severe disorders of consciousness in the post-acute phase underwent an experimental protocol of sensory stimulation based on biographically meaningful objects. Enriched stimulation was compared to both a pattern of stimulation without augmented context and to standard interactions in a clinical setting. An A-B-C-B-A paradigm was applied to minimize the confounding effects of clinical changes during the protocol. The motor behaviours were recorded using the Wessex Head Injury Matrix (WHIM) and analysed with standard parametric statistics. Results and conclusions: The results show a difference in patient response as a function of stimulation context: familiar objects in an augmented environment elicited a greater range of behavioural responses. These results support the hypothesis that the emotional richness and complexity of environmental stimuli can play a key role in evoking active behaviours. [ABSTRACT FROM AUTHOR]