Early Prediction of Malignant Brain Edema After Ischemic Stroke

Abstract

Background and Purpose— Malignant brain edema after ischemic stroke has high mortality but limited treatment. Therefore, early prediction is important, and we systematically reviewed predictors and predictive models to identify reliable markers for the development of malignant edema. Methods— We searched Medline and Embase from inception to March 2018 and included studies assessing predictors or predictive models for malignant brain edema after ischemic stroke. Study quality was assessed by a 17-item tool. Odds ratios, mean differences, or standardized mean differences were pooled in random-effects modeling. Predictive models were descriptively analyzed. Results— We included 38 studies (3278 patients) with 24 clinical factors, 7 domains of imaging markers, 13 serum biomarkers, and 4 models. Generally, the included studies were small and showed potential publication bias. Malignant edema was associated with younger age (n=2075; mean difference, −4.42; 95% CI, −6.63 to −2.22), higher admission National Institutes of Health Stroke Scale scores (n=807, median 17–20 versus 5.5–15), and parenchymal hypoattenuation >50% of the middle cerebral artery territory on initial computed tomography (n=420; odds ratio, 5.33; 95% CI, 2.93–9.68). Revascularization (n=1600, odds ratio, 0.37; 95% CI, 0.24–0.57) were associated with a lower risk for malignant edema. Four predictive models all showed an overall C statistic >0.70, with a risk of overfitting. Conclusions— Younger age, higher National Institutes of Health Stroke Scale, and larger parenchymal hypoattenuation on computed tomography are reliable early predictors for malignant edema. Revascularization reduces the risk of malignant edema. Future studies with robust design are needed to explore optimal cutoff age and National Institutes of Health Stroke Scale scores and to validate and improve existing models.

Impaired consciousness at stroke onset in large hemisphere infarction: incidence, risk factors and outcome

“…The predictors of malignant brain edema using clinical and radiological variables have been thoroughly investigated for the last two decades. Systematic reviews have demonstrated that younger age, higher baseline NIHSS, and infarct size were major predictors for malignant edema after stroke 39 – 40 . However, whether IC on admission associated with malignant brain edema or not remains controversial 10 , 17 , 25 – 28 , 41 .…”

Neuroprotective Effects of Isosteviol Sodium in Murine Brain Capillary Cerebellar Endothelial Cells (cerebEND) After Hypoxia

“…However, even cells in this region will die, due to the following phenomenon. First, cerebral edema occurs and reperfusion is not established during the early hours since the diffusion length for oxygen remains too long and collateral circulation is inadequate to maintain the permanent neuronal demand for OGD indefinitely (Heiss, 2012;Wu et al, 2018). Second, the so-called ischemia-reperfusion injury.…”

A web based dynamic MANA Nomogram for predicting the malignant cerebral edema in patients with large hemispheric infarction

“…Previous clinical research has indicated demographic, clinical and radiographic predictors for MCE [ 7 – 10 ]. Reported predictors of MCE included younger age, higher National Institutes of Health Stroke Scale (NIHSS) [ 7 ], larger parenchymal hypoattenuation on computed tomography (CT) [ 11 ], hyperdense artery sign and higher blood glucose [ 10 ]. In recent years, diffusion weighted imaging (DWI) has been extensively used for MCE prediction [ 7 , 9 ].…”