title: Predictors of malignant brain edema in middle cerebral artery infarction observed on CT angiography.
abstract: Patients with middle cerebral artery (MCA) infarction accompanied by MCA occlusion with or without internal carotid artery (ICA) occlusion have a poor prognosis, as a result of brain cell damage caused by both the infarction and by space-occupying and life-threatening edema formation. Multiple treatments can reduce the likelihood of edema formation, but tend to show limited efficacy. Decompressive hemicraniectomy with duroplasty has been promising for improving functional outcomes and reducing mortality, particularly improved functional outcomes can be achieved with early decompressive surgery. Therefore, identifying patients at risk for developing fatal edema is important and should be performed as early as possible. Sixty-four patients diagnosed with major MCA infarction with MCA occlusion within 8 hours of symptom onset were retrospectively reviewed. Early clinical, laboratory, and computed tomography angiography (CTA) parameters were analyzed for malignant brain edema (MBE). Twenty of the 64 patients (31%) had MBE, and the clinical outcome was poor (3month modified Rankin Scale >2) in 95% of them. The National Institutes of Health Stroke Scale (NIHSS) score, Alberta Stroke Program Early Computed Tomography Score, Clot Burden Score, and Collateral Score (CS) showed statically significant differences in both groups. Multivariable analyses adjusted for age and sex identified the independent predictors of MBE: NIHSS score >18 (odds ratio [OR]: 4.4, 95% confidence interval [CI]: 1.2-16.0, p=0.023) and CS on CTA <2 (OR: 7.28, 95% CI: 1.7-30.3,p=0.006). Our results provide useful information for selecting patients in need of aggressive treatment such as decompressive surgery.
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Hoon
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pochang, Republic of Korea.
authors.forename: Seon Tak
authors.initials: ST
authors.lastname: Jin
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Young Woo
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Seong Rim
authors.initials: SR
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea.
authors.forename: Ik Seong
authors.initials: IS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Republic of Korea. Electronic address: jkw94@naver.com.
authors.forename: Kwang Wook
authors.initials: KW
authors.lastname: Jo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging* / Q000601:surgery; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States
keywords: ASPECTS; CT angiography; Edema; Ischemic stroke