The effect of brain atrophy on outcome after a large cerebral infarction.
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.
Lee
Sang Hyung
SH
Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea.
Oh
Chang Wan
CW
Han
Jung Ho
JH
Kim
Chae-Yong
CY
Kwon
O-Ki
OK
Son
Young-Je
YJ
Bae
Hee-Joon
HJ
Han
Moon-Ku
MK
Chung
Young Seob
YS
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