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Decompressive Surgery for Malignant Middle Cerebral Artery Territory Infarction

Ruprecht-Karls-Universitat, Heidelberg, Germany; E-mail: werner_hacke{at}med.uni-heidelberg.de

EXTRACT

INTRODUCTION: THE SYNDROME AND ITS PROGNOSIS

Early death after acute ischaemic stroke is most frequently caused by space occupying ischaemic brain oedema. With complete middle cerebral artery (MCA) territory infarction, including the basal ganglia, and occasionally additional infarction of the anterior cerebral artery or the posterior cerebral artery territories, the large post ischaemic oedematous infarct may cause mass effect, raised intracranial pressure (ICP), and so herniation and brain death (Hacke et al. 1996; Frank 1995; Ropper 1984; Berrouschot et al. 1998). Clinically, the patients present with dense hemiplegia, head- and eye-deviation, progressive deterioration of consciousness over the first 24–48 h and reduced ventilatory drive. Herniation occurs between day 2 and day 5 after onset. Because older patients tend to have more brain atrophy, this condition is more frequently seen among patients under 60 years of age.

Brain oedema formation depends on the size of infarct, location of vessel occlusion ...

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