Predictors of life-threatening brain edema in middle cerebral artery infarction.
BACKGROUND
We performed a systematic review to identify predictors of the development of life-threatening brain edema in patients with middle cerebral artery infarction.


METHODS
We searched Medline from January 1966 and Embase from January 1974 to April 2007 for cohort and case-control studies on predictors of life-threatening edema in patients with middle cerebral artery infarction. Crude data were used to calculate risk ratios, odds ratios, or weighted mean differences.


RESULTS
Infarct size was the major determinant of the development of life-threatening edema. Other associated determinants were early mass effect, involvement of other vascular territories, higher body temperature, internal carotid artery occlusion, and need for mechanical ventilation. However, predictive values were only moderate.


CONCLUSIONS
The size of the ischemic area is the major determinant. Single predictors lack sufficient predictive value to select candidates for surgical decompression before the onset of clinical signs of herniation.
Hofmeijer
Jeannette
J
Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands. j.hofmeijer@umcutrecht.nl
Algra
Ale
A
Kappelle
L Jaap
LJ
van der Worp
H Bart
HB
D001929:Brain Edema / Q000209:etiology*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000150:complications* / Q000473:pathology; D012307:Risk Factors