Which patient fares worse after early deterioration due to swelling from hemispheric stroke?
The authors studied 24 patients admitted to the neurointensive care unit because of clinical deterioration to drowsiness or stupor and midline shift after complete middle cerebral artery infarction (coMCAI) stroke. Fourteen (58%) experienced further deterioration and either underwent hemicraniectomy or refused surgery and died. These patients were significantly more likely to be female (72% vs 20%) and to have additional vascular territorial infarction (72% vs 0%) on initial CT. These features may help to identify patients at high risk for further deterioration after coMCAI.
Maramattom
Boby V
BV
Division of Neurology Critical Care, Department of Neurology, Mayo Clinic, Rochester, MN 55903, USA.
Bahn
Mark M
MM
Wijdicks
Eelco F M
EF
D000368:Aged; D001929:Brain Edema / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D003131:Combined Modality Therapy; D003244:Consciousness Disorders / Q000209:etiology*; D003399:Craniotomy; D019299:Decompression, Surgical; D018450:Disease Progression; D004292:Dominance, Cerebral; D004677:Encephalocele / Q000209:etiology / Q000401:mortality; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
D008353:Mannitol