title: Malignant middle cerebral artery infarction: a clinical study of 32 patients.
abstract: OBJECTIVE
  Malignant middle cerebral artery infarction is a devastating type of ischemic stroke whose clinical predictors remain scarcely known. The present study aims to improve the knowledge about the prognosis factors through an analysis of a malignant middle cerebral artery infarction sample of patients from our stroke registry.
  
  
  METHODS
  From a total of 1,396 patients with ischemic stroke in the middle cerebral artery included in the "Sagrat Cor Hospital of Barcelona Stroke Registry", we identified 32 patients with malignant middle cerebral artery infarction (2.3%). Demographic, anamnestic, clinical, and outcome variables in this subgroup of patients were compared with those of the middle cerebral artery. The independent predictive value of each variable on the development of malignant middle cerebral artery infarction was assessed with a logistic regression analysis.
  
  
  RESULTS
  The mean age was 74.7 (SD, 11.4) years and 50% were males. In-hospital death was observed in eight patients (25%) and early bad prognosis (in-hospital death or severe residual focality at discharge) was present in 16 patients (50%). Decreased consciousness (OR: 4.17; 95% CI: 2.02-8.61), presence of nausea or vomiting (OR: 3.65; 95% CI: 1.40-8.49), and heavy smoking (> 20 cigarettes/day; OR: 2.62; 95% CI: 1.03-6.64) appeared to be independent prognostic factors for malignant middle cerebral artery infarction in the multivariate analysis.
  
  
  CONCLUSIONS
  Malignant middle cerebral artery infarction is an infrequent clinical condition associated with poor prognosis and high mortality rate. In our sample, decreased consciousness, nausea or vomiting, and heavy smoking are the main clinical factors associated.
authors: Cerebrovascular Division, Neurology Department, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain.
authors: Adrià
authors: A
authors: Arboix
authors: Unit for Organization, Planning and Information Systems, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain.
authors: Luís
authors: L
authors: García-Eroles
authors: Cerebrovascular Division, Neurology Department, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain.
authors: Montserrat
authors: M
authors: Oliveres
authors: Cerebrovascular Division, Neurology Department, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain.
authors: Emili
authors: E
authors: Comes
authors: Library, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain.
authors: María José
authors: MJ
authors: Sánchez
authors: Cerebrovascular Division, Neurology Department, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Catalonia, Spain.
authors: Joan
authors: J
authors: Massons
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000401:mortality / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012042:Registries; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D020521:Stroke / Q000401:mortality / Q000503:physiopathology*; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology