title: Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review.
abstract: OBJECTIVE
  To determine the time interval between symptom onset and neurologic deterioration related to cerebral edema in patients with massive middle cerebral artery infarction. The time period between onset and neurologic deterioration represents the window for surgical intervention.
  
  
  METHODS
  Multicenter retrospective chart review.
  
  
  METHODS
  Five university-affiliated medical centers.
  
  
  METHODS
  Fifty-three patients with massive middle cerebral artery infarction who experienced neurologic deterioration defined by a decrease in the Glasgow Coma Scale score of two or more points attributable to mass effect.
  
  
  RESULTS
  A total of 53 patients (mean age, 62 +/- 18 yrs; 25 [47%] were men) with neurologic deterioration were identified by using International Classification of Diseases (9th revision) codes and local registries. Medical records and neuroimaging studies were reviewed by a stroke neurologist or neurointensivist to identify the time of neurologic deterioration. Thrombolytics were used at presentation in 19 (35%) patients. A total of 19 (36%) patients had neurologic deterioration within 24 hrs of symptom onset. By 48 hrs, 36 (68%) patients had manifested clinical deterioration. A few patients had later neurologic deterioration on day 3 (n = 10), day 4 (n = 2), day 5 (n = 2), and day 6 or after (n = 3). A total of 25 (47%) of the 53 patients died during hospitalization. The highest frequency of deaths occurred on day 3.
  
  
  CONCLUSIONS
  Neurologic deteriorations related to cerebral edema after massive middle cerebral artery infarction occur in most patients within 48 hrs of symptom onset.
authors.affiliation: Department of Neurosurgery, State University of New York at Buffalo, USA.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.forename: Jose I
authors.initials: JI
authors.lastname: Suarez
authors.forename: Abutaher M
authors.initials: AM
authors.lastname: Yahia
authors.forename: Yousef
authors.initials: Y
authors.lastname: Mohammad
authors.forename: Guven
authors.initials: G
authors.lastname: Uzun
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
authors.forename: Osama O
authors.initials: OO
authors.lastname: Zaidat
authors.forename: Cenk
authors.initials: C
authors.lastname: Ayata
authors.forename: Zulfiqar
authors.initials: Z
authors.lastname: Ali
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Wityk
mesh_terms: D001929:Brain Edema / Q000503:physiopathology*; D019299:Decompression, Surgical; D018450:Disease Progression; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors