Parkinson's Disease, Depression, and Quality-of-Life.

BACKGROUND: Depression is the most common psychiatric disorder associated with Parkinson's disease (PD) but is often under diagnosed and under treated leading to worsening of symptoms and deterioration of the quality-of-life of the people suffering from this disease. AIMS: The current study aims to determine the correlation between depression and health-related quality-of-life (HRQOL) domains in patients with PD. MATERIALS AND METHODS: A sample of 65 consecutive patients attending the specialty Parkinson's clinic was assessed by a psychiatrist as part of the treatment protocol. Diagnosis of depression was done using the International Classification of Diseases-10 by a psychiatrist and depression was scored using the Geriatric Depression Scale (GDS). QOL-BREF Malayalam version was used to assess quality-of-life in the patients. STATISTICAL ANALYSIS: One-way ANOVA was used to find the difference in the quality-of-life experienced by different age categories, duration of the disease, psychiatric co-morbidity. Independent sample t-test was used to find the difference in the quality-of-life experienced by genders, co morbid conditions and to find the difference in the scores on GDS and domains of WHO QOL BREF. Association of H and Y staging and duration of Parkinsonism with GDS Scores were computed using Pearson's Chi-square test. RESULTS AND CONCLUSIONS: There was a significant association of female gender and depression with the physical and psychological domains of QOL while the duration and staging of PD did not have any association with QOL Domains. Depression thus emerges as one of the main predictors of poor quality-of-life in PD.

An unusual extra-axial hypodense lesion mimicking a chronic subdural haematoma.

A 59-year-old man was found on the road with multiple injuries. CT scan showed a hypodense extra axial lesion in the left fronto-temporal region suggestive of chronic subdural haematoma. He was treated conservatively but did not improve. He underwent craniectomy after lesion was shown to be increasing in size, only solid tissue was seen which was not biopsied. Patient made good recovery after steroids were put on. He deteriorated again 6 weeks later and radiology showed the frontal lesion without involvement of the brain and with minimal enhancement and mass effect. He underwent biopsy decompression of the lesion with steroids, post-operatively he improved well, but deteriorated when the steroids were tapered. Histopathology report was Non-Hodgkin's lymphoma. No primary was found and the patient died during oncology treatment. This illustrates manifestation of primary dural lymphoma radiologically mimicking chronic subdural haematoma, another common disorder.

Decompressive hemicraniectomy in large putaminal hematomas: an Indian experience.

OBJECTIVE: The treatment of large putaminal hematomas is predominantly medical and the role of surgery is debated. Decompressive hemicraniectomy in large hemispheric infarctions has been reported to lower mortality and improve outcomes. Decompressive hemicraniectomy may also have a role in putaminal hematomas. METHODS: In all, 23 patients with putaminal hematoma who underwent decompressive craniectomy in the last 4 years were analyzed. Parameters investigated included clinical presentations, radiologic profile, time interval from ictus to surgery, and Glasgow outcome score at 1 month. RESULTS: There were 13 men and 10 women with ages ranging from 31 to 68 years. All of them presented with neurologic deficits. Seven patients had a Glasgow Coma Scale (GCS) score of 3 to 8, 12 had a GCS score of 9 to 12, and GCS score was above 13 in 4. Seventeen patients had known hypertension. Computed tomography scan was done in all. The hematoma was less than 3 cm in 5 cases, 3 to 5 cm in 11, and larger than 5 cm in 7; and was 30 mL or less in 3, 30 to 60 mL in 13, and more than 60 mL in 7. All patients underwent hemicraniectomy on the side of the lesion and dura was left open. At 3 months, 13 patients had a good outcome and 10 had a poor outcome (including 3 deaths). CONCLUSIONS: Decompressive hemicraniectomy can be a useful alternative surgical procedure in moderate to large putaminal hematomas.

Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method.

OBJECTIVE: Chronic subdural haematoma is a disease of the elderly and surgery in these patients carries a much higher risk. The common surgical procedures for chronic subdural haematoma include twist drill craniostomy, burr hole evacuation or craniotomy. The aim of this study was to analyse the results of twist drill craniostomy with drainage in elderly patients with chronic subdural haematoma. METHODS: Forty-two elderly patients (>65 years) with radiologically proven chronic subdural haematoma were analysed. All the patients underwent twist drill craniostomy and continuous drainage of the haematoma under local anaesthesia and total intravenous anaesthesia (TIVA). RESULTS: There were 24 males and 18 females. Headache and cognitive decline was seen in 50% and weakness of limbs in 60% of patients. CT scan was done in all cases. All patients underwent twist drill 2-3 cm in front of the parietal eminence under local anaesthesia. The drain was left for 24-72 h depending on the drainage. At 1 week, 88% of patients had a good outcome. CONCLUSION: Twist drill craniostomy with drainage under local anaesthesia is a safe and effective procedure for chronic subdural haematoma in the elderly and could be used as the first and only option in these people.