Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care.
OBJECTIVE
To find what the mortality rate of space-occupying ('malignant') middle cerebral artery (MCA) infarction is under maximum conservative intensive care. To establish whether any early indicators of survival exist.


METHODS
Prospective descriptive study.


METHODS
Neuro-critical care unit of a university hospital.


METHODS
Fifty-three patients (mean age 64 +/- 10 years) with 'malignant' MCA infarction.


METHODS
Maximum conservative intensive care using a standardized protocol (heparin, osmotherapy, tromethamol, mild hyperventilation). The start of therapy was within 12 h after the onset of symptoms.


RESULTS
The Glasgow Coma Scale (GCS) and Scandinavian Stroke Scale (SSS) were recorded daily. A computed tomography (CT) scan was performed on admission, on day 3 and on day 7. SSS, Barthel Index and Rankin Scale of the surviving patients were recorded after 3 months. On admission, the mean GCS was 13 +/- 3 points and mean SSS 18 +/- 7 points. All patients had to undergo mechanical ventilation (23 +/- 26 h after the onset of symptoms) and were comatose after 28 +/- 30 h. Of 53 patients, 37 (70%) suffered brain death in the intensive care unit (ICU) after an average of 90 +/- 59 h. After 3 months 42/53 (79 %) patients had died. The Barthel Index of the surviving patients was 54 +/- 12 points, the SSS 25 +/- 9 points and the Rankin Scale 3 +/- 1 points. The deceased patients had a significantly higher body temperature on admission than the surviving patients (36.8 degrees C vs 36.3 degrees C).


CONCLUSIONS
The mortality of patients with 'malignant' MCA infarction is very high despite maximum conservative intensive care.
Department of Neurology, University of Leipzig, Germany.
J
J
Berrouschot
M
M
Sterker
S
S
Bettin
J
J
Köster
D
D
Schneider
D000328:Adult; D000368:Aged; D001831:Body Temperature; D001921:Brain / Q000000981:diagnostic imaging; D002544:Cerebral Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D016009:Chi-Square Distribution; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D018450:Disease Progression; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome