title: Managing malignant cerebral infarction.
abstract: Managing patients with malignant cerebral infarction remains one of the foremost challenges in medicine. These patients are at high risk for progressive neurologic deterioration and death due to malignant cerebral edema, and they are best cared for in the intensive care unit of a comprehensive stroke center. Careful initial assessment of neurologic function and of findings on MRI, coupled with frequent reassessment of clinical and radiologic findings using CT or MRI are mandatory to promote the prompt initiation of treatments that will ensure the best outcome in these patients. Significant deterioration in either neurologic function or radiologic findings or both demand timely treatment using the best medical management, which may include osmotherapy (mannitol or hypertonic saline), endotracheal intubation, and mechanical ventilation. Under appropriate circumstances, decompressive craniectomy may be warranted to improve outcome or to prevent death.
authors.affiliation: Department of Neurosurgery, University of Maryland School of Medicine, 22 S. Greene St., Suite S12D, Baltimore, MD, 21201-1595, USA.
authors.forename: J Marc
authors.initials: JM
authors.lastname: Simard
authors.forename: Juan
authors.initials: J
authors.lastname: Sahuquillo
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
authors.forename: Kristopher T
authors.initials: KT
authors.lastname: Kahle
authors.forename: Brian P
authors.initials: BP
authors.lastname: Walcott