同侧脑静脉流出道梗阻致大脑中动脉区脑梗死的致命性水肿课件.pptxVIP

2007;6(3):215-22 Hemicraniectomy improves outcome of malignant MCA stroke • 3 clinical trials: DECIMAL, HAMLET, and DESTINY. • 93 patients randomized to surgical or medical therapy. • Patients ≤60 years of age. • The timing of surgery 48 hrs after stroke onset. • Outcome with mRS at 1 yr. Questions • Not every MCA stroke patient develops fatal edema. • Hemicraniectomy could be associated with complications, such as intracranial hemorrhage, infection, and CSF leakage. • How to predict which patient will need surgery? • Early predictors of fatal edema include – infarct size, – young age, – female gender, – NIH Stroke Scale score 20 on admission, – elevated white blood cell counts, – hypertension, heart failure, – ipsilateral abnormal circle of Willis, and carotid occlusion. • Infarct size is the major determinant, but its predictive value is only moderate. Prediction of the Development of Fatal Edema • To investigate the relevance of the ipsilateral cerebral venous sinuses in the development of fatal edema. Aim of Our Study Methods • A retrospective study • All consecutive patients with large MCA infarction admitted to our Neurointensive Care Unit from January 2007 to October 2008 were included. • Medical records, laboratory data, and imaging studies were analyzed. • Patients with malignant MCA infarction were compared with those with non-malignant MCA infarction. Results P t A ge S ex Infarction Etiology Maxim al midline shift (mm) Ipsilateral transverse Sinuses (TS) Ipsilateral internal jugular vein (IJ) mRS at dischar ge 1 67 m R-MCA Embolic 2 dominant dominant 3 2 81 f R-MCA Embolic 3.4 dominant NA 4 3 69 m L-MCA ICA occlusion 16.1 hypoplastic NA 6 4 60 m L-MCA Embolic 4.6 NA NA 5 5 38 m L-MCA ICA occlusion 6.4 NA NA 3 6 37 m R-MCA Vasculitis 1 NA NP 6 7 64 m R-MCA ICA dissection 16.8 NA occluded 6 8 46 m L-M oAte: NA, n rCm l appearan dissection ce 1.9 dominant dominant 3 9 7