Predictors of malignant brain edema in middle cerebral artery infarction observed on CT angiography

Abstract Patients with middle cerebral artery (MCA) infarction accompanied by MCA occlusion with or without internal carotid artery (ICA) occlusion have a poor prognosis, as a result of brain cell damage caused by both the infarction and by space-occupying and life-threatening edema formation. Multi...

Full description

Saved in:
Bibliographic Details
Published in:Journal of clinical neuroscience 2015-03, Vol.22 (3), p.554-560
Main Authors: Kim, Hoon, Jin, Seon Tak, Kim, Young Woo, Kim, Seong Rim, Park, Ik Seong, Jo, Kwang Wook
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
ASPECTS
Brain - diagnostic imaging
Brain - surgery
Brain Edema - diagnostic imaging
Brain Edema - surgery
Cerebral Angiography
CT angiography
Edema
Female
Humans
Infarction, Middle Cerebral Artery - diagnostic imaging
Infarction, Middle Cerebral Artery - surgery
Ischemic stroke
Male
Middle Aged
Neurology
Retrospective Studies
United States
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Abstract Patients with middle cerebral artery (MCA) infarction accompanied by MCA occlusion with or without internal carotid artery (ICA) occlusion have a poor prognosis, as a result of brain cell damage caused by both the infarction and by space-occupying and life-threatening edema formation. Multiple treatments can reduce the likelihood of edema formation, but tend to show limited efficacy. Decompressive hemicraniectomy with duroplasty has been promising for improving functional outcomes and reducing mortality, particularly improved functional outcomes can be achieved with early decompressive surgery. Therefore, identifying patients at risk for developing fatal edema is important and should be performed as early as possible. Sixty-four patients diagnosed with major MCA infarction with MCA occlusion within 8 hours of symptom onset were retrospectively reviewed. Early clinical, laboratory, and computed tomography angiography (CTA) parameters were analyzed for malignant brain edema (MBE). Twenty of the 64 patients (31%) had MBE, and the clinical outcome was poor (3 month modified Rankin Scale >2) in 95% of them. The National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early Computed Tomography Score, Clot Burden Score, and Collateral Score (CS) showed statically significant differences in both groups. Multivariable analyses adjusted for age and sex identified the independent predictors of MBE: NIHSS score >18 (odds ratio [OR]: 4.4, 95% confidence interval [CI]: 1.2–16.0, p = 0.023) and CS on CTA
ISSN:0967-5868
1532-2653
DOI:10.1016/j.jocn.2014.08.021