title: The effect of brain atrophy on outcome after a large cerebral infarction.
abstract: OBJECTIVE
  We retrospectively evaluated the effect of brain atrophy on the outcome of patients after a large cerebral infarct.
  
  
  METHODS
  Between June 2003 and Oct 2008, 134 of 2975 patients with stroke were diagnosed as having a large cerebral infarct. The mean age of the patients was 70 (21-95) y. The mean infarct volume was 223.6±95.2 cm(3) (46.0-491.0). The inter-caudate distance (ICD) was calculated as an indicator of brain atrophy by measuring the hemi-ICD of the intact side and then multiplying by two to account for brain swelling at the infarct site. The mean ICD was 18.0±4.8 mm (9.6-37.6).
  
  
  RESULTS
  Forty-nine (36.6%) patients experienced a malignant clinical outcome (MCO) during management in the hospital. Thirty-one (23.1%) patients had a favourable functional outcome (FO) (modified Rankin scale (mRS) ≤3) and 49 (36.6%) had an acceptable functional outcome (AO) (mRS≤4) at 6 months after stroke onset. In the multivariate analysis, brain atrophy (ICD≥20 mm) had a significant and independent protective effect on MCO (p=0.003; OR=0.137; 95% CI 0.037 to 0.503). With respect to FO, the age and infarct volume reached statistical significance (p<0.001, OR=0.844, 95% CI 0.781 to 0.913; p=0.006, OR=0.987, 95% CI 0.977 to 0.996, respectively). Brain atrophy (ICD≥20 mm) was negatively associated only with AO (p=0.022; OR=0.164; 95% CI 0.035 to 0.767).
  
  
  CONCLUSIONS
  Brain atrophy may have an association with clinical outcome after a large stroke by a trend of saving patients from an MCO but also by interfering with their functional recovery.
authors.affiliation: Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Sang Hyung
authors.initials: SH
authors.lastname: Lee
authors.forename: Chang Wan
authors.initials: CW
authors.lastname: Oh
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Chae-Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.forename: Young-Je
authors.initials: YJ
authors.lastname: Son
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.forename: Young Seob
authors.initials: YS
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D001929:Brain Edema / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D002421:Caudate Nucleus / Q000473:pathology; D002423:Cause of Death; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D056424:Decompressive Craniectomy; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009929:Organ Size / Q000502:physiology; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult