Risk factors for post-traumatic massive cerebral infarction secondary to space-occupying epidural hematoma.
Post-traumatic massive cerebral infarction (MCI) is a fatal complication of concurrent epidural hematoma (EDH) and brain herniation that commonly requires an aggressive decompressive craniectomy. The risk factors and surgical indications of MCI have not been fully elucidated. In this retrospective study, post-traumatic MCI was diagnosed in 32 of 176 patients. The performance of a decompressive craniectomy simultaneously with the initial hematoma-evacuation surgery improved their functional outcomes, compared with delayed surgery (on the 6-month Extended Glasgow Outcome Scale, 5.6±1.5 vs. 3.4±0.6; p<0.001). Significantly increased risks for MCI were observed in patients with an EDH at a transtemporal location (adjusted odds ratio [OR], 16.48; p=0.003), an EDH larger than 100 mL in volume (OR, 7.04; p=0.001), preoperative shock for longer than 30 min (OR, 13.78; p=0.002), bilateral mydriasis (OR, 7.08; p=0.004), preoperative brain herniation for longer than 90 min (OR, 6.41; p<0.001), and a Glasgow Coma Score of 3-5 points (OR, 2.86; p<0.053). Multi-variate logistic regression analysis revealed no significant association between post-traumatic MCI and age, gender, mid-line shift, Rotterdam computed tomography score, intraoperative hypotension, or serum concentrations of sodium or glucose. Incidence of post-traumatic MCI increased from 16.4% in those having any two of the six risk factors to 47.7% in those having any three or more of the six risk factors (p<0.001). Patients with concurrent EDH and brain herniation exhibited an increased risk for post-traumatic MCI with the accumulation of several critical clinical factors. Early decompressive craniectomy based on accurate risk estimation is recommended in efforts to improve patient functional outcomes.
Department of Neurosurgery, the 175th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University , Zhangzhou, China .
Wen-hao
WH
Wang
Lian-shui
LS
Hu
Hong
H
Lin
Jun
J
Li
Fei
F
Luo
Wei
W
Huang
Jun-ming
JM
Lin
Gen-ping
GP
Cai
Chang-chun
CC
Liu
D000293:Adolescent; D000328:Adult; D000368:Aged; D002544:Cerebral Infarction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D056424:Decompressive Craniectomy; D005260:Female; D023261:Glasgow Outcome Scale; D006407:Hematoma, Epidural, Cranial / Q000150:complications* / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
brain herniation; cerebral infarction; craniotomy; decompressive craniectomy; epidural hematoma