Clinical and Radiological Predictors of Malignant Middle Cerebral Artery Infarction Development and Outcomes

Autor: Angelique F. Albert, Matthew A. Kirkman
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Tomography Scanners
X-Ray Computed
Traumatic brain injury
medicine.medical_treatment
Statistics as Topic
03 medical and health sciences
0302 clinical medicine
Midline shift
medicine.artery
Middle Cerebral Artery Infarction
Humans
Medicine
cardiovascular diseases
Stroke
Aged
Retrospective Studies
Intracranial pressure
Analysis of Variance
business.industry
Endovascular Procedures
Rehabilitation
Infarction
Middle Cerebral Artery
Optic Nerve
030208 emergency & critical care medicine
Middle Aged
Decompression
Surgical
medicine.disease
Surgery
Treatment Outcome
Radiological weapon
Middle cerebral artery
cardiovascular system
Female
Decompressive craniectomy
Neurology (clinical)
Radiology
Cardiology and Cardiovascular Medicine
business
030217 neurology & neurosurgery
Zdroj: Journal of Stroke and Cerebrovascular Diseases. 26:2671-2679
ISSN: 1052-3057
Popis: Optic nerve sheath diameter (ONSD) can predict intracranial hypertension and outcomes in severe traumatic brain injury. Its utility in middle cerebral artery (MCA) stroke is unknown.We reviewed serial radiological measurements, including ONSD, in patients with MCA stroke undergoing decompressive craniectomy (DC) for malignant MCA syndrome and compared demographic, clinical, and radiological data with an age- and gender-matched group of nonmalignant MCA stroke patients.Patients admitted to a large tertiary hospital in London, UK, between April 2012 and October 2016 with MCA infarction were identified through 2 data sources. We quantified ONSD, eyeball transverse diameter (ETD), ONSD/ETD ratio, midline shift (MLS), and infarct volume on computed tomography (CT).We identified 19 patients (mean age = 49.8 years [standard deviation = 12.5]) with malignant MCA stroke and 19 patients (47.8 years [16.0]) with nonmalignant MCA stroke. Mean ONSD, ONSD/ETD ratio, MLS, and infarct volume on initial CT all significantly increased after developing malignant MCA syndrome and decreased (except infarct volume, which increased) following DC (all Ps.05). ONSD and ONSD/ETD ratios in the malignant group did not correlate with functional outcomes but were significantly higher on initial CT compared with the nonmalignant group (mean ONSD: 5.66 mm [.6] versus 4.97 mm [.5], P = .001; mean ONSD/ETD ratio: .25 [.03] versus .22 [.02], P = .002).ONSD, ONSD/ETD ratio, MLS, and infarct volume change dynamically in patients with malignant MCA infarction who undergo DC. An ONSD of more than 5.25 mm and an ONSD/ETD ratio of more than .232 on initial CT may identify MCA stroke patients at high risk of developing malignant MCA syndrome.
Databáze: OpenAIRE
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