Massive cerebral infarction.
BACKGROUND
Massive cerebral infarcts cause brain edema with midline shifts and impingement on vital structures producing coma and death. The mortality rate is estimated at 80% with standard medical treatment. Surgical decompression with hemicraniectomy has proved to be life saving, but the impact on functional outcomes is largely unknown. The focus of this review is to discuss the treatment options for massive cerebral infarcts.


RESULTS
Neurologic deterioration following massive cerebral infarct needs to be recognized early enough for medical and surgical interventions. Medical management includes monitoring in a neurologic intensive care unit, hyperosmolar agents, and hyperventilation. Surgical management includes decompressive hemicraniectomy and duraplasty with resection of infarcted tissue in some instances.


CONCLUSIONS
Hemicraniectomy is emerging as a promising treatment of patients with massive cerebral infarcts, but only select patients benefit from this procedure. Further information from randomized controlled trials is required to elucidate the best treatment options for this kind of stroke.
Subramaniam
Suresh
S
Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada.
Hill
Michael D
MD
D001794:Blood Pressure / Q000502:physiology; D001929:Brain Edema / Q000209:etiology; D002544:Cerebral Infarction / Q000150:complications / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D018450:Disease Progression; D006801:Humans; D007036:Hypothermia, Induced; D019635:Neurosurgical Procedures; D014883:Water-Electrolyte Imbalance / Q000628:therapy