Skip to main content
SpringerLink
Log in

Malignant Ischemic Infarction

  • Chapter
Surgical Intensive Care Medicine

  • 2608 Accesses

Abstract

Large ischemic infarctions have been associated with high mortality rates for years. The most reliable predictors of a “malignant” course for a large hemispheric infarction are hypodensity in more than 50 % of the MCA territory on computed tomography (CT) as well as stroke volume >145 mL on diffusion-weighted imaging. Deterioration of consciousness is a first sign of swelling after cerebellar infarction. Decompressive surgery within 48 h after symptom onset in patients less than 60 years old reduces mortality and severe disability after large hemispheric stroke. Occipital decompression along with extraventricular drainage is recommended for treatment of swelling cerebellar infarction.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hacke W, Schwab S, Horn M, Spranger M, De Georgia M, von Kummer R. ‘Malignant’ middle cerebral artery territory infarction: clinical course and prognostic signs. Arch Neurol. 1996;53:309–15.

    Article  CAS  PubMed  Google Scholar 

  2. Kasner SE, Demchuk AM, Berrouschot J, Schmutzhard E, Harms L, Verro P, et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke. 2001;32:2117–23.

    Article  CAS  PubMed  Google Scholar 

  3. Qureshi AI, Suarez JI, Yahia AM, Mohammad Y, Uzun G, Suri MF, et al. Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review. Crit Care Med. 2003;31:272–7.

    Article  PubMed  Google Scholar 

  4. Frank JI. Large hemispheric infarction, deterioration, and intracranial pressure. Neurology. 1995;45:1286–90.

    Article  CAS  PubMed  Google Scholar 

  5. Berrouschot J, Sterker M, Bettin S, Koster J, Schneider D. Mortality of space-occupying (‘malignant’) middle cerebral artery infarction under conservative intensive care. Intensive Care Med. 1998;24:620–3.

    Article  CAS  PubMed  Google Scholar 

  6. Rahme R, Curry R, Kleindorfer D, Khoury JC, Ringer AJ, Kissela BM, et al. How often are patients with ischemic stroke eligible for decompressive hemicraniectomy? Stroke. 2012;43:550–2.

    Article  PubMed  Google Scholar 

  7. Hofmeijer J, Kappelle LJ, Algra A, Amelink GJ, van Gijn J, van der Worp HB. Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol. 2009;8:326–33.

    Article  PubMed  Google Scholar 

  8. Juttler E, Schwab S, Schmiedek P, Unterberg A, Hennerici M, Woitzik J, et al. Decompressive surgery for the treatment of malignant infarction of the middle cerebral artery (DESTINY): a randomized, controlled trial. Stroke. 2007;38:2518–25.

    Article  PubMed  Google Scholar 

  9. Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol. 2007;6:215–22.

    Article  PubMed  Google Scholar 

  10. Vahedi K, Vicaut E, Mateo J, Kurtz A, Orabi M, Guichard JP, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke. 2007;38:2506–17.

    Article  PubMed  Google Scholar 

  11. Brozici M, van der Zwan A, Hillen B. Anatomy and functionality of leptomeningeal anastomoses: a review. Stroke. 2003;34:2750–62.

    Article  PubMed  Google Scholar 

  12. Jaramillo A, Gongora-Rivera F, Labreuche J, Hauw JJ, Amarenco P. Predictors for malignant middle cerebral artery infarctions: a postmortem analysis. Neurology. 2006;28(66):815–20.

    Article  Google Scholar 

  13. Juttler E, Schweickert S, Ringleb PA, Huttner HB, Kohrmann M, Aschoff A. Long-term outcome after surgical treatment for space-occupying cerebellar infarction: experience in 56 patients. Stroke. 2009;40:3060–6.

    Article  PubMed  Google Scholar 

  14. Kudo H, Kawaguchi T, Minami H, Kuwamura K, Miyata M, Kohmura E. Controversy of surgical treatment for severe cerebellar infarction. J Stroke Cerebrovasc Dis. 2007;16:259–62.

    Article  PubMed  Google Scholar 

  15. Pfefferkorn T, Eppinger U, Linn J, Birnbaum T, Herzog J, Straube A, et al. Long-term outcome after suboccipital decompressive craniectomy for malignant cerebellar infarction. Stroke. 2009;40:3045–50.

    Article  PubMed  Google Scholar 

  16. Jauss M, Krieger D, Hornig C, Schramm J, Busse O. Surgical and medical management of patients with massive cerebellar infarctions: results of the German-Austrian Cerebellar Infarction Study. J Neurol. 1999;246:257–64.

    Article  CAS  PubMed  Google Scholar 

  17. Kirollos RW, Tyagi AK, Ross SA, van Hille PT, Marks PV. Management of spontaneous cerebellar hematomas: a prospective treatment protocol. Neurosurgery. 2001;49:1378–86.

    Article  CAS  PubMed  Google Scholar 

  18. Heinsius T, Bogousslavsky J, Van Melle G. Large infarcts in the middle cerebral artery territory. Etiology and outcome patterns. Neurology. 1998;50:341–50.

    Article  CAS  PubMed  Google Scholar 

  19. Ropper AH, Shafran B. Brain edema after stroke. Clinical syndrome and intracranial pressure. Arch Neurol. 1984;41:26–9.

    Article  CAS  PubMed  Google Scholar 

  20. Poca MA, Benejam B, Sahuquillo J, Riveiro M, Frascheri L, Merino MA, et al. Monitoring intracranial pressure in patients with malignant middle cerebral artery infarction: is it useful? J Neurosurg. 2010;112:648–57.

    Article  PubMed  Google Scholar 

  21. Edlow JA, Newman-Toker DE, Savitz SI. Diagnosis and initial management of cerebellar infarction. Lancet Neurol. 2008;7:951–64.

    Article  PubMed  Google Scholar 

  22. Koh MG, Phan TG, Atkinson JL, Wijdicks EF. Neuroimaging in deteriorating patients with cerebellar infarcts and mass effect. Stroke. 2000;31:2062–7.

    Article  CAS  PubMed  Google Scholar 

  23. Maramattom BV, Bahn MM, Wijdicks EF. Which patient fares worse after early deterioration due to swelling from hemispheric stroke? Neurology. 2004;63:2142–5.

    Article  PubMed  Google Scholar 

  24. Krieger DW, Demchuk AM, Kasner SE, Jauss M, Hantson L. Early clinical and radiological predictors of fatal brain swelling in ischemic stroke. Stroke. 1999;30:287–92.

    Article  CAS  PubMed  Google Scholar 

  25. Wang KW, Chang WN, Ho JT, Chang HW, Lui CC, Cheng MH, et al. Factors predictive of fatality in massive middle cerebral artery territory infarction and clinical experience of decompressive hemicraniectomy. Eur J Neurol. 2006;13:765–71.

    Article  PubMed  Google Scholar 

  26. Oppenheim C, Samson Y, Manai R, Lalam T, Vandamme X, Crozier S, et al. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke. 2000;31:2175–81.

    Article  CAS  PubMed  Google Scholar 

  27. Thomalla GJ, Kucinski T, Schoder V, Fiehler J, Knab R, Zeumer H, et al. Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging. Stroke. 2003;34:1892–9.

    Article  PubMed  Google Scholar 

  28. Kruetzelmann A, Hartmann F, Beck C, Juettler E, Singer OC, Kohrmann M, et al. Combining magnetic resonance imaging within six-hours of symptom onset with clinical follow-up at 24 h improves prediction of ‘malignant’ middle cerebral artery infarction. Int J Stroke. 2014;9:210–4.

    Article  PubMed  Google Scholar 

  29. Barber PA, Demchuk AM, Zhang J, Kasner SE, Hill MD, Berrouschot J, et al. Computed tomographic parameters predicting fatal outcome in large middle cerebral artery infarction. Cerebrovasc Dis. 2003;16:230–5.

    Article  PubMed  Google Scholar 

  30. Foerch C, Otto B, Singer OC, Neumann-Haefelin T, Yan B, Berkefeld J, et al. Serum S100B predicts a malignant course of infarction in patients with acute middle cerebral artery occlusion. Stroke. 2004;35:2160–4.

    Article  CAS  PubMed  Google Scholar 

  31. Serena J, Blanco M, Castellanos M, Silva Y, Vivancos J, Moro MA, et al. The prediction of malignant cerebral infarction by molecular brain barrier disruption markers. Stroke. 2005;36:1921–6.

    Article  CAS  PubMed  Google Scholar 

  32. Manno EM, Nichols DA, Fulgham JR, Wijdicks EF. Computed tomographic determinants of neurologic deterioration in patients with large middle cerebral artery infarctions. Mayo Clin Proc. 2003;78:156–60.

    Article  PubMed  Google Scholar 

  33. Pullicino PM, Alexandrov AV, Shelton JA, Alexandrova NA, Smurawska LT, Norris JW. Mass effect and death from severe acute stroke. Neurology. 1997;49:1090–5.

    Article  CAS  PubMed  Google Scholar 

  34. Moulin T, Cattin F, Crepin-Leblond T, Tatu L, Chavot D, Piotin M, et al. Early CT signs in acute middle cerebral artery infarction: predictive value for subsequent infarct locations and outcome. Neurology. 1996;47:366–75.

    Article  CAS  PubMed  Google Scholar 

  35. Kucinski T, Koch C, Grzyska U, Freitag HJ, Kromer H, Zeumer H. The predictive value of early CT and angiography for fatal hemispheric swelling in acute stroke. AJNR Am J Neuroradiol. 1998;19:839–46.

    CAS  PubMed  Google Scholar 

  36. Thomalla G, Hartmann F, Juettler E, Singer OC, Lehnhardt FG, Kohrmann M, et al. Prediction of malignant middle cerebral artery infarction by magnetic resonance imaging within 6 hours of symptom onset: a prospective multicenter observational study. Ann Neurol. 2010;68:435–45.

    Article  PubMed  Google Scholar 

  37. Haring HP, Dilitz E, Pallua A, Hessenberger G, Kampfl A, Pfausler B, et al. Attenuated corticomedullary contrast: an early cerebral computed tomography sign indicating malignant middle cerebral artery infarction. A case-control study. Stroke. 1999;30:1076–82.

    Article  CAS  PubMed  Google Scholar 

  38. Park J, Goh DH, Sung JK, Hwang YH, Kang DH, Kim Y. Timely assessment of infarct volume and brain atrophy in acute hemispheric infarction for early surgical decompression: strict cutoff criteria with high specificity. Acta Neurochir (Wien). 2012;154:79–85.

    Article  Google Scholar 

  39. Lee SJ, Lee KH, Na DG, Byun HS, Kim YB, Shon YM, et al. Multiphasic helical computed tomography predicts subsequent development of severe brain edema in acute ischemic stroke. Arch Neurol. 2004;61:505–9.

    Article  PubMed  Google Scholar 

  40. Ryoo JW, Na DG, Kim SS, Lee KH, Lee SJ, Chung CS, et al. Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps. J Comput Assist Tomogr. 2004;28:55–62.

    Article  PubMed  Google Scholar 

  41. Dittrich R, Kloska SP, Fischer T, Nam E, Ritter MA, Seidensticker P, et al. Accuracy of perfusion-CT in predicting malignant middle cerebral artery brain infarction. J Neurol. 2008;255:896–902.

    Article  CAS  PubMed  Google Scholar 

  42. Bektas H, Wu TC, Kasam M, Harun N, Sitton CW, Grotta JC, et al. Increased blood-brain barrier permeability on perfusion CT might predict malignant middle cerebral artery infarction. Stroke. 2010;41:2539–44.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Minnerup J, Wersching H, Ringelstein EB, Heindel W, Niederstadt T, Schilling M, et al. Prediction of malignant middle cerebral artery infarction using computed tomography-based intracranial volume reserve measurements. Stroke. 2011;42:3403–9.

    Article  PubMed  Google Scholar 

  44. Limburg M, van Royen EA, Hijdra A, de Bruine JF, Verbeeten Jr BW. Single-photon emission computed tomography and early death in acute ischemic stroke. Stroke. 1990;21:1150–5.

    Article  CAS  PubMed  Google Scholar 

  45. Firlik AD, Yonas H, Kaufmann AM, Wechsler LR, Jungreis CA, Fukui MB, et al. Relationship between cerebral blood flow and the development of swelling and life-threatening herniation in acute ischemic stroke. J Neurosurg. 1998;89:243–9.

    Article  CAS  PubMed  Google Scholar 

  46. Berrouschot J, Barthel H, von Kummer R, Knapp WH, Hesse S, Schneider D. 99m technetium-ethyl-cysteinate-dimer single-photon emission CT can predict fatal ischemic brain edema. Stroke. 1998;29:2556–62.

    Article  CAS  PubMed  Google Scholar 

  47. Lampl Y, Sadeh M, Lorberboym M. Prospective evaluation of malignant middle cerebral artery infarction with blood-brain barrier imaging using Tc-99m DTPA SPECT. Brain Res. 2006;1113:194–9.

    Article  CAS  PubMed  Google Scholar 

  48. Dohmen C, Bosche B, Graf R, Staub F, Kracht L, Sobesky J, et al. Prediction of malignant course in MCA infarction by PET and microdialysis. Stroke. 2003;34:2152–8.

    Article  PubMed  Google Scholar 

  49. Schneweis S, Grond M, Staub F, Brinker G, Neveling M, Dohmen C, et al. Predictive value of neurochemical monitoring in large middle cerebral artery infarction. Stroke. 2001;32:1863–7.

    Article  CAS  PubMed  Google Scholar 

  50. Dohmen C, Bosche B, Graf R, Reithmeier T, Ernestus RI, Brinker G, et al. Identification and clinical impact of impaired cerebrovascular autoregulation in patients with malignant middle cerebral artery infarction. Stroke. 2007;38:56–61.

    Article  PubMed  Google Scholar 

  51. Wartenberg KE. Malignant middle cerebral artery infarction. Curr Opin Crit Care. 2012;18:152–63.

    Article  PubMed  Google Scholar 

  52. Hofmeijer J, Algra A, Kappelle LJ, van der Worp HB. Predictors of life-threatening brain edema in middle cerebral artery infarction. Cerebrovasc Dis. 2008;25:176–84.

    Article  PubMed  Google Scholar 

  53. Bosche B, Dohmen C, Graf R, Neveling M, Staub F, Kracht L, et al. Extracellular concentrations of non-transmitter amino acids in peri-infarct tissue of patients predict malignant middle cerebral artery infarction. Stroke. 2003;34:2908–13.

    Article  CAS  PubMed  Google Scholar 

  54. Heiss WD, Dohmen C, Sobesky J, Kracht L, Bosche B, Staub F, et al. Identification of malignant brain edema after hemispheric stroke by PET-imaging and microdialysis. Acta Neurochir. 2003;86:237–40.

    CAS  Google Scholar 

  55. Diedler J, Sykora M, Juttler E, Veltkamp R, Steiner T, Rupp A. EEG power spectrum to predict prognosis after hemicraniectomy for space-occupying middle cerebral artery infarction. Cerebrovasc Dis. 2010;29:162–9.

    Article  PubMed  Google Scholar 

  56. Dohmen C, Sakowitz OW, Fabricius M, Bosche B, Reithmeier T, Ernestus RI, et al. Spreading depolarizations occur in human ischemic stroke with high incidence. Ann Neurol. 2008;63:720–8.

    Article  PubMed  Google Scholar 

  57. Wijdicks EF, Sheth KN, Carter BS, Greer DM, Kasner SE, Kimberly WT, et al. Recommendations for the management of cerebral and cerebellar infarction with swelling: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:1222–38.

    Article  PubMed  Google Scholar 

  58. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. E Engl J Med. 1995;333:1581–7.

    Google Scholar 

  59. Ringleb PA, Bousser MG, Ford G, Bath P, Brainin M, Caso V, et al. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis. 2008;25:457–507.

    Article  Google Scholar 

  60. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.

    Article  CAS  PubMed  Google Scholar 

  61. Adams Jr HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007;115:478–534.

    Article  Google Scholar 

  62. Jauch EC, Saver JL, Adams Jr HP, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947.

    Article  PubMed  Google Scholar 

  63. Wechsler LR. Intravenous thrombolytic therapy for acute ischemic stroke. N Engl J Med. 2011;364:2138–46.

    Article  CAS  PubMed  Google Scholar 

  64. The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349:1569–81.

    Google Scholar 

  65. Meyers PM, Schumacher HC, Connolly Jr ES, Heyer EJ, Gray WA, Higashida RT. Current status of endovascular stroke treatment. Circulation. 2011;123:2591–601.

    Article  PubMed  PubMed Central  Google Scholar 

  66. del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. PROACT Investigators. Prolyse in Acute Cerebral Thromboembolism. Stroke. 1998;29:4–11.

    Article  PubMed  Google Scholar 

  67. Furlan A, Higashida R, Wechsler L, Gent M, Rowley H, Kase C, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism. JAMA. 1999;282:2003–11.

    Article  CAS  PubMed  Google Scholar 

  68. Lee M, Hong KS, Saver JL. Efficacy of intra-arterial fibrinolysis for acute ischemic stroke: meta-analysis of randomized controlled trials. Stroke. 2010;41:932–7.

    Article  PubMed  Google Scholar 

  69. Ciccone A, Valvassori L. Endovascular treatment for acute ischemic stroke. N Engl J Med. 2013;368:2433–4.

    Article  PubMed  CAS  Google Scholar 

  70. Broderick JP, Palesch YY, Demchuk AM, Yeatts SD, Khatri P, Hill MD, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med. 2013;368:893–903.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Kidwell CS, Jahan R, Gornbein J, Alger JR, Nenov V, Ajani Z, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med. 2013;368:914–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365:993–1003.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Smith WS, Sung G, Saver J, Budzik R, Duckwiler G, Liebeskind DS, et al. Mechanical thrombectomy for acute ischemic stroke: final results of the Multi MERCI trial. Stroke. 2008;39:1205–12.

    Article  PubMed  Google Scholar 

  74. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP, et al. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke. 2005;36:1432–8.

    Article  PubMed  Google Scholar 

  75. Berrouschot J, Rossler A, Koster J, Schneider D. Mechanical ventilation in patients with hemispheric ischemic stroke. Crit Care Med. 2000;28:2956–61.

    Article  CAS  PubMed  Google Scholar 

  76. Koenig MA, Bryan M, Lewin 3rd JL, Mirski MA, Geocadin RG, Stevens RD. Reversal of transtentorial herniation with hypertonic saline. Neurology. 2008;70:1023–9.

    Article  CAS  PubMed  Google Scholar 

  77. Diringer MN, Scalfani MT, Zazulia AR, Videen TO, Dhar R. Cerebral hemodynamic and metabolic effects of equi-osmolar doses mannitol and 23.4% saline in patients with edema following large ischemic stroke. Neurocrit Care. 2011;14:11–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Schwarz S, Schwab S, Bertram M, Aschoff A, Hacke W. Effects of hypertonic saline hydroxyethyl starch solution and mannitol in patients with increased intracranial pressure after stroke. Stroke. 1998;29:1550–5.

    Article  CAS  PubMed  Google Scholar 

  79. Kamel H, Navi BB, Nakagawa K, Hemphill 3rd JC, Ko NU. Hypertonic saline versus mannitol for the treatment of elevated intracranial pressure: a meta-analysis of randomized clinical trials. Crit Care Med. 2011;39:554–9.

    Article  CAS  PubMed  Google Scholar 

  80. Hays AN, Lazaridis C, Neyens R, Nicholas J, Gay S, Chalela JA. Osmotherapy: use among neurointensivists. Neurocrit Care. 2011;14:222–8.

    Article  CAS  PubMed  Google Scholar 

  81. van der Worp HB, Sena ES, Donnan GA, Howells DW, Macleod MR. Hypothermia in animal models of acute ischaemic stroke: a systematic review and meta-analysis. Brain. 2007;130:3063–74.

    Article  PubMed  Google Scholar 

  82. Schwab S, Schwarz S, Spranger M, Keller E, Bertram M, Hacke W. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke. 1998;29:2461–6.

    Article  CAS  PubMed  Google Scholar 

  83. Steiner T, Friede T, Aschoff A, Schellinger PD, Schwab S, Hacke W. Effect and feasibility of controlled rewarming after moderate hypothermia in stroke patients with malignant infarction of the middle cerebral artery. Stroke. 2001;32:2833–5.

    Article  CAS  PubMed  Google Scholar 

  84. Schwab S, Georgiadis D, Berrouschot J, Schellinger PD, Graffagnino C, Mayer SA. Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke. 2001;32:2033–5.

    Article  CAS  PubMed  Google Scholar 

  85. Georgiadis D, Schwarz S, Aschoff A, Schwab S. Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke. 2002;33:1584–8.

    Article  CAS  PubMed  Google Scholar 

  86. Milhaud D, Thouvenot E, Heroum C, Escuret E. Prolonged moderate hypothermia in massive hemispheric infarction: clinical experience. J Neurosurg Anesthesiol. 2005;17:49–53.

    PubMed  Google Scholar 

  87. Els T, Oehm E, Voigt S, Klisch J, Hetzel A, Kassubek J. Safety and therapeutical benefit of hemicraniectomy combined with mild hypothermia in comparison with hemicraniectomy alone in patients with malignant ischemic stroke. Cerebrovasc Dis. 2006;21:79–85.

    Article  PubMed  Google Scholar 

  88. Neugebauer H, Kollmar R, Niesen WD, Bosel J, Schneider H, Hobohm C, et al. DEcompressive surgery Plus hypoTHermia for Space-Occupying Stroke (DEPTH-SOS): a protocol of a multicenter randomized controlled clinical trial and a literature review. Int J Stroke. 2013;8:383–7.

    Article  PubMed  Google Scholar 

  89. Johnson RD, Maartens NF, Teddy PJ. Technical aspects of decompressive craniectomy for malignant middle cerebral artery infarction. J Clin Neurosci. 2011;18:1023–7.

    Article  PubMed  Google Scholar 

  90. Chung J, Bang OY, Lim YC, Park SK, Shin YS. Newly suggested surgical method of decompressive craniectomy for patients with middle cerebral artery infarction. Neurologist. 2011;17:11–5.

    Article  PubMed  Google Scholar 

  91. Fischer U, Taussky P, Gralla J, Arnold M, Brekenfeld C, Reinert M, et al. Decompressive craniectomy after intra-arterial thrombolysis: safety and outcome. J Neurol Neurosurg Psychiatry. 2011;82:885–7.

    Article  PubMed  Google Scholar 

  92. Staykov D, Gupta R. Hemicraniectomy in malignant middle cerebral artery infarction. Stroke. 2011;42:513–6.

    Article  PubMed  Google Scholar 

  93. Sundseth J, Sundseth A, Berg-Johnsen J, Sorteberg W, Lindegaard KF. Cranioplasty with autologous cryopreserved bone after decompressive craniectomy. Complications and risk factors for developing surgical site infection. Acta Neurochir (Wien). 2014;156:805–11.

    Article  CAS  Google Scholar 

  94. Ewald C, Duenisch P, Walter J, Gotz T, Witte OW, Kalff R, et al. Bone flap necrosis after decompressive hemicraniectomy for malignant middle cerebral artery infarction. Neurocrit Care. 2014;20:91–7.

    Article  PubMed  Google Scholar 

  95. Akins PT, Guppy KH. Sinking skin flaps, paradoxical herniation, and external brain tamponade: a review of decompressive craniectomy management. Neurocrit Care. 2008;9:269–76.

    Article  PubMed  Google Scholar 

  96. Waziri A, Fusco D, Mayer SA, McKhann 2nd GM, Connolly Jr ES. Postoperative hydrocephalus in patients undergoing decompressive hemicraniectomy for ischemic or hemorrhagic stroke. Neurosurgery. 2007;61:489–93.

    Article  PubMed  Google Scholar 

  97. Rahme R, Weil AG, Sabbagh M, Moumdjian R, Bouthillier A, Bojanowski MW. Decompressive craniectomy is not an independent risk factor for communicating hydrocephalus in patients with increased intracranial pressure. Neurosurgery. 2010;67:675–8.

    Article  PubMed  Google Scholar 

  98. Sarov M, Guichard JP, Chibarro S, Guettard E, Godin O, Yelnik A, et al. Sinking skin flap syndrome and paradoxical herniation after hemicraniectomy for malignant hemispheric infarction. Stroke. 2010;41:560–2.

    Article  PubMed  Google Scholar 

  99. Cho DY, Chen TC, Lee HC. Ultra-early decompressive craniectomy for malignant middle cerebral artery infarction. Surg Neurol. 2003;60:227–32.

    Article  PubMed  Google Scholar 

  100. Gupta R, Connolly ES, Mayer S, Elkind MS. Hemicraniectomy for massive middle cerebral artery territory infarction: a systematic review. Stroke. 2004;35:539–43.

    Article  PubMed  Google Scholar 

  101. Mori K, Aoki A, Yamamoto T, Horinaka N, Maeda M. Aggressive decompressive surgery in patients with massive hemispheric embolic cerebral infarction associated with severe brain swelling. Acta Neurochir (Wien). 2001;143:483–91.

    Article  CAS  Google Scholar 

  102. Schwab S, Steiner T, Aschoff A, Schwarz S, Steiner HH, Jansen O, et al. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke. 1998;29:1888–93.

    Article  CAS  PubMed  Google Scholar 

  103. Walz B, Zimmermann C, Bottger S, Haberl RL. Prognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction. J Neurol. 2002;249:1183–90.

    Article  PubMed  Google Scholar 

  104. Uhl E, Kreth FW, Elias B, Goldammer A, Hempelmann RG, Liefner M, et al. Outcome and prognostic factors of hemicraniectomy for space occupying cerebral infarction. J Neurol Neurosurg Psychiatry. 2004;75:270–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  105. Frank JI CD, Thisted R, Kordeck C, Schumm P, Maratea J. HeADDFIRST Trialists Hemicraniectomy and durotomy upon deterioration from infarction related swelling trial (HeADDFIRST): first public presentation of the primary study findings. Abstract and Scientific Session, 55th Annual Meeting of the American Academy of Neurology, March 19–April 5, 2003.

    Google Scholar 

  106. Juttler E, Unterberg A, Woitzik J, Bosel J, Amiri H, Sakowitz OW, et al. Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med. 2014;370:1091–100.

    Article  PubMed  CAS  Google Scholar 

  107. Kelly AG, Holloway RG. Health state preferences and decision-making after malignant middle cerebral artery infarctions. Neurology. 2010;75:682–7.

    Article  PubMed  PubMed Central  Google Scholar 

  108. Weil AG, Rahme R, Moumdjian R, Bouthillier A, Bojanowski MW. Quality of life following hemicraniectomy for malignant MCA territory infarction. Can J Neurol Sci. 2011;38:434–8.

    Article  PubMed  Google Scholar 

  109. Kiphuth IC, Kohrmann M, Lichy C, Schwab S, Huttner HB. Hemicraniectomy for malignant middle cerebral artery infarction: retrospective consent to decompressive surgery depends on functional long-term outcome. Neurocrit Care. 2010;13:380–4.

    Article  PubMed  Google Scholar 

  110. Schmidt H, Heinemann T, Elster J, Djukic M, Harscher S, Neubieser K, et al. Cognition after malignant media infarction and decompressive hemicraniectomy--a retrospective observational study. BMC Neurol. 2011;11:77.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Neugebauer H, Creutzfeldt CJ, Hemphill 3rd JC, Heuschmann PU, Juttler E. DESTINY-S: attitudes of physicians toward disability and treatment in malignant MCA infarction. Neurocrit Care. 2014;21:27–34.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurointensive Care Unit, Department of Neurology, Martin-Luther-University, Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle, Germany

    Katja E. Wartenberg MD, PhD

Authors
  1. Katja E. Wartenberg MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katja E. Wartenberg MD, PhD .

Editor information

Editors and Affiliations

  1. Department of Surgical Critical Care; Lahey Hospital and Medical Center, Division of Surgery, Burlington, Massachusetts, USA

    John M. O'Donnell

  2. Surgical Critical Care Medicine, Pr�-Card�o Hospital, Critical Care Medicine, University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

    Flávio E. Nácul

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Wartenberg, K.E. (2016). Malignant Ischemic Infarction. In: O'Donnell, J., Nácul, F. (eds) Surgical Intensive Care Medicine. Springer, Cham. https://doi.org/10.1007/978-3-319-19668-8_17

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-19668-8_17

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-19667-1

  • Online ISBN: 978-3-319-19668-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation