Neuroprotection in malignant MCA infarction.
Massive unilateral hemispheric infarction often develops progressive postischemic edema that leads to a malignant course of stroke with mortality of up to 80% with conventional medical therapies. Hypothermia and decompressive hemicraniectomy have shown neuroprotective effects in several animal models of focal transient and permanent MCA occlusion by reducing infarct size and improving neurological outcome. Our aim in this paper was to review the possible mechanisms of both therapies as well as the optimal time window and duration of application of each treatment in animal model and in human malignant MCA infarction reported in the literature.
Delgado
Pilar
P
Department of Neurology, Vall d'Hebron Hospital, Barcelona, Spain. 35070pdm@comb.es
Sahuquillo
Juan
J
Poca
M Antonia
MA
Alvarez-Sabin
José
J
D000818:Animals; D001929:Brain Edema / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003399:Craniotomy; D019299:Decompression, Surgical / Q000379:methods; D004195:Disease Models, Animal; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019586:Intracranial Hypertension / Q000401:mortality / Q000601:surgery*; D009626:Terminology as Topic; D013997:Time Factors