Document Detail

Outcome after external decompression for massive cerebral infarction.
MedLine Citation:
PMID:  9597855     Owner:  NLM     Status:  MEDLINE    
Acute ischemic stroke involving the entire vascular distribution of a carotid or middle cerebral artery can cause massive cerebral edema. This study evaluated external decompression for the treatment of massive stroke and analyzed possible prognostic factors. Twenty-four patients with acute massive cerebral infarction, which had progressed to tentorial herniation and impending death, underwent external decompression after medical therapy failed to achieve an effective response. The neurological outcome 2 months after surgery using the Glasgow Outcome Scale was severe disability in 14 patients, vegetative state in two, and death in eight. The overall mortality was 33%. Various characteristics (age, sex, etiology, side of hemispheric infarction, pupillary asymmetry, Japan Coma Scale, distribution of infarction, hemorrhagic infarction, midline shift, tentorial herniation) were evaluated to determine the factors associated with high mortality after surgical intervention. There was no statistically significant relationship between any variable and mortality. Mortality was especially high in the patients with preoperative consciousness level of 200, anterior, middle, and posterior cerebral artery territory infarction, and stage III of tentorial herniation. Postoperatively, all patients with severe disability returned to a clear level of consciousness. Six patients with dominant hemisphere stroke had some measure of communicative skills in spite of aphasia. External decompression is a life-saving treatment for patients with massive cerebral infarction and can provide a reasonable quality of life even for those with dominant hemisphere strokes. Decompressive surgery should be considered and performed as soon as possible if computed tomography demonstrates signs of descending tentorial herniation.
K Sakai; K Iwahashi; K Terada; Y Gohda; M Sakurai; Y Matsumoto
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Neurologia medico-chirurgica     Volume:  38     ISSN:  0470-8105     ISO Abbreviation:  Neurol. Med. Chir. (Tokyo)     Publication Date:  1998 Mar 
Date Detail:
Created Date:  1998-06-29     Completed Date:  1998-06-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0400775     Medline TA:  Neurol Med Chir (Tokyo)     Country:  JAPAN    
Other Details:
Languages:  eng     Pagination:  131-5; discussion 135-6     Citation Subset:  IM    
Department of Neurosurgery, Kagawa Prefectural Central Hospital, Takamatsu, Japan.
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MeSH Terms
Acute Disease
Aged, 80 and over
Atrial Fibrillation / complications
Brain Edema / etiology,  surgery*
Brain Ischemia / complications,  surgery*
Cerebral Infarction / complications,  surgery*
Consciousness Disorders / etiology,  surgery
Critical Care
Encephalocele / etiology,  mortality,  radiography,  surgery
Evaluation Studies as Topic
Glasgow Coma Scale
Middle Aged
Mydriasis / etiology,  surgery
Persistent Vegetative State / etiology
Quality of Life
Retrospective Studies
Risk Factors
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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