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Cerebral edema in acute ischemic stroke patients treated with intravenous thrombolysis.
MedLine Citation:
PMID:  22405327     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Cerebral edema (CED) deteriorates outcome of ischemic stroke patients, and there is no effective medical treatment. Limited data exist on cerebral edema after stroke thrombolysis. AIMS: We aimed to analyze impact of cerebral edema on the outcome of thrombolysis-treated patients. METHODS: Our cohort included 943 thrombolysis-treated ischemic stroke patients at the Helsinki University Central Hospital (1995-2008). Cerebral edema represented focal brain swelling up to 1/3 (CED-1) or greater than 1/3 (CED-2) of the hemisphere, or midline shift (CED-3). We studied baseline parameters associated with development of cerebral edema and association of cerebral edema with three-month outcome (modified Rankin Scale, mRS). RESULTS: On control imaging, CED-1 was present in 167 (17·7%), CED-2 in 40 (4·2%), and CED-3 in 53 (5·6%) patients. Compared with patients without edema (n = 683), patients with cerebral edema had higher baseline National Institutes of Health Stroke Scale scores, more often hyperdense cerebral artery sign or early infarct signs on admission computerized tomography, and received thrombolysis later. Cerebral edema was independently associated with poor outcome (mRS 3-6) and mortality, whereas favorable outcome (mRS 0-2) was observed in 77 (46%), 5 (13%), and 3 (6%) patients with CED 1, 2, and 3, respectively. Anti-edema treatment was considered necessary and administered to 49/260 (19%) patients; only five had favorable outcome. CONCLUSIONS: Cerebral edema is frequent (28%) among thrombolysis-treated ischemic stroke patients, occurring in severe forms in 10%. Higher baseline National Institutes of Health Stroke Scale, presence of hyperdense cerebral artery sign or early infarct signs, and longer treatment delays are associated with edema development. Edema is a strong independent predictor of three-month outcome. Effect of anti-edema treatment was modest.
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-9
Journal Detail:
Title:  International journal of stroke : official journal of the International Stroke Society     Volume:  -     ISSN:  1747-4949     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101274068     Medline TA:  Int J Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 The Authors. International Journal of Stroke © 2012 World Stroke Organization.
Affiliation:
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
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Investigator
Investigator/Affiliation:
Daniel Strbian / ; Atte Meretoja / ; Jukka Putaala / ; Markku Kaste / ; Turgut Tatlisumak /

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