Background and Objective. Studies on decompressive craniectomy (DCE) after a malignant middle cerebral artery (MCA) stroke in selected population show an increased probability of survival without increasing the number of very severely disabled. Cerebral infarct volume (CIV) as a triage criterion for performing surgery has not been discussed in literature. The aim of this study was to investigate the value of CIV and initial National Institutes of Health Stroke Scale (NIHHS) and Glasgow Coma Scale (GCS) scores as possible triage criteria in the surgical treatment of patients with “malignant” MCA stroke. Material and Methods. According to the study protocol, 28 patients with a malignant MCA stroke were included and analyzed prospectively. The patients were randomly divided either into the DCE plus best medical treatment (BMT) group or BMT alone group. CIV and NIHHS and GCS scores were measured at time of enrollment in every case. Clinical outcome was evaluated 1 year after the treatment. Results. Six patients survived: 5 in the DCE group (none of them was older than 60 years) and 1 in the BMT group (P=0.03/0.06). Among survivors, none had a cerebral infarct volume of more than 390 cm3 (P=0.05). All survivors in the DCE group had favorable outcomes. There was no significant difference in the NIHSS and GCS scores between the groups and survivors/nonsurvivors (P>0.05). Conclusions. Decompressive surgery in the selected patients is likely to increase the probability of survival with a favorable outcome without increasing the number of severely disabled survivors. Patients with CIV of more than 390 cm3 may be bad candidates for DCE, and the prognosis is likely to be bad regardless the treatment strategy. The initial NIHHS and GCS scores did not prove any prognostic value in outcome.

Implementation of the Guidelines was associated with a statistically significant decrease of HCFR in TBI patients.

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Better knowledge of clinical epidemiology and course of aneurysmal subarachnoid hemorrhage (ASAH) is essential for dedicated planning of the need for services. The aim of the study was to obtain a picture of epidemiology and clinical course of ASAH in Riga City (the capital of Latvia). A retrospective population-based study included residents of Riga City who suffered their first ASAH during a 5-year period from the beginning of 1996 till the end of 2000. The total number of ASAH events in the population during the study period was 292, of which 56 (19%) were fatal before reaching the hospital. There was no significant difference between age-specific incidence rates in men and women. The mean ASAH rates per 100 000 per year were 10.3 for age-adjusted incidence (in the population aged 20-79 years) and 7.2 for crude incidence. The mean age-adjusted case fatality rates were 57% for all ASAH events and 45% for those who survived admission. Our data suggest that incidence of ASAH in Baltic population can be recognized as average compared with other European regions. However, the case fatality rate of ASAH in the study population was higher than those of SAH reported from MONICA Collaborating Centers.