Malignant Middle Cerebral Artery Infarction: Dos and Don’t for Survival
Sung-Il Sohn, MD, PhD Sung-Il Sohn, MD, PhD
Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
ABSTRACT
Malignant infarction of the middle cerebral artery (MCA) is associated with an 80% mortality rate. No medical treatment has been proven effective. But decompressive hemicraniectomy and induced hypothermia have been proposed to relieve the mass effect and tissue shifts. Further analyses of current trial data suggest that in particular patient age and timing of hemicraniectomy determine outcome. Identification of patients at risk to develop malignant cerebral edema after massive infarcts is therefore of importance. Different predictors of fatal brain edema formation have been identified, such as large volume or area on early CT or MRI and midline shifting on repeated CT or transcranial color-coded duplex sonography. Nevertheless, there is no proven therapy for all patients with malignant MCA infarction. In order to guide the management of individual patients, carefully adjusted medical care, ongoing futility analysis, and simultaneous health professionals meetings should be conducted to reach a joint decision addressing any ethical concerns.
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