Timing of neurologic deterioration in massive middle cerebral artery infarction: A multicenter review

Abstract

Neurologic deteriorations related to cerebral edema after massive middle cerebral artery infarction occur in most patients within 48 hrs of symptom onset.

Hypoplasia or Occlusion of the Ipsilateral Cranial Venous Drainage Is Associated With Early Fatal Edema of Middle Cerebral Artery Infarction

“…Most patients with malignant MCA infarction develop fatal edema within 48 hours of ictus. 8 A number of studies have shown that infarct size is the major determinant of the development of fatal edema. [1][2][3][4] However, its predictive value is only moderate and other factors may play a role.…”

Timing of Decompressive Hemicraniectomy for Stroke

“…5 Previous publications have found that the progression of cerebral edema after acute infarction ranges between 2 and 5 days: while 68% of patients exhibit clinical deterioration within 48 hours of symptom onset, almost one third of patients experience worsening of sensorium after 48 hours. 6 In such cases, clinicians are faced with a dilemma of pursuing a hemicraniectomy before significant neurological deterioration from mass effect has transpired, or performing surgery outside of the recommended interval. In addition, inappropriate patient selection and overutilization of surgery is suboptimal, as decompressive craniectomy carries a risk of additional perioperative complications, including infection and reoperation.…”

Multimodal Reperfusion Therapy for Large Hemispheric Infarcts in Octogenarians: Is Good Outcome a Realistic Goal?

“…[3][4][5][6] In most cases, mortality is caused by brain herniation secondary to increased intracranial pressure resulting from stroke-associated edema. [7][8][9] The only way to prevent such a malignant course of events seems to be rapid tissue reperfusion after arterial recanalization. The chances of recanalizing the occluded vessel and restoring perfusion appear to be somewhat higher with endovascular approaches that combine more than one treatment technique, [10][11][12][13][14][15][16][17][18][19][20] and this is now considered a valid therapeutic approach in many patients with large strokes.…”