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The Swedish Malignant Middle cerebral artery Infarction Study: Long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care

Malm, J ; Bergenheim, AT ; Enblad, P ; Hardemark, HG ; Koskinen, LOD ; Naredi, S ; Nordström, Carl-Henrik ; Norrving, B ; Uhlin, J and Lindgren, Arne LU (2006) In Acta Neurologica Scandinavica 113(1). p.25-30
Abstract
Hemicraniectomy in patients with malignant middle cerebral artery (mMCA) infarct may be life-saving. The long-term prognosis is unknown. Patients with mMCA infarct treated with hemicraniectomy between 1998 and 2002 at three hospitals were included. The criterion for surgical intervention was if the patients deteriorated from awake to being responding to painful stimuli only. All patients were followed for at least 1 year. Outcome was defined as alive/dead, walkers/non-walkers or modified Rankin Scale (mRS) score <= 2. Thirty patients were included (median age at stroke onset 49 years, range 17-67 years). Fourteen patients had mMCA infarct on the left side and 16 patients on the right side. Fourteen patients had pupil dilatation before... (More)
Hemicraniectomy in patients with malignant middle cerebral artery (mMCA) infarct may be life-saving. The long-term prognosis is unknown. Patients with mMCA infarct treated with hemicraniectomy between 1998 and 2002 at three hospitals were included. The criterion for surgical intervention was if the patients deteriorated from awake to being responding to painful stimuli only. All patients were followed for at least 1 year. Outcome was defined as alive/dead, walkers/non-walkers or modified Rankin Scale (mRS) score <= 2. Thirty patients were included (median age at stroke onset 49 years, range 17-67 years). Fourteen patients had mMCA infarct on the left side and 16 patients on the right side. Fourteen patients had pupil dilatation before surgery. Hemicraniectomy was performed at a median of 52 h (range 13-235 h) after stroke onset. Nine patients died within 1 month after surgery because of cerebral herniation (n = 6), myocardial infarction (n = 1) or intensive care complications (n = 2). No further deaths occurred during follow-up, which was at median 3.4 years after surgery. Status for the 21 survivors at the last follow-up was: mRS 2 or less (n = 6) and mRS 3-5 (n = 15). The oldest patient with mRS 2 or less was 53 years at stroke onset. Thirteen patients (43%) could walk without substantial aid. The long-term survival after mMCA infarction treated with hemicraniectomy seems to be favourable if the patient survives the acute phase. The outcome as measured with mRS may be better among younger patients. (Less)
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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
intracranial pressure, cerebral infarction, brain oedema, prognosis
in
Acta Neurologica Scandinavica
volume
113
issue
1
pages
25 - 30
publisher
Wiley-Blackwell
external identifiers
  • wos:000233806600005
  • pmid:16367895
  • scopus:33645239097
ISSN
1600-0404
DOI
10.1111/j.1600-0404.2005.00537.x
language
English
LU publication?
yes
id
1bf5a1b7-874d-4e67-9190-65de0fa3fa95 (old id 693870)
date added to LUP
2016-04-01 15:54:05
date last changed
2021-10-10 04:17:05
@article{1bf5a1b7-874d-4e67-9190-65de0fa3fa95,
  abstract     = {Hemicraniectomy in patients with malignant middle cerebral artery (mMCA) infarct may be life-saving. The long-term prognosis is unknown. Patients with mMCA infarct treated with hemicraniectomy between 1998 and 2002 at three hospitals were included. The criterion for surgical intervention was if the patients deteriorated from awake to being responding to painful stimuli only. All patients were followed for at least 1 year. Outcome was defined as alive/dead, walkers/non-walkers or modified Rankin Scale (mRS) score &lt;= 2. Thirty patients were included (median age at stroke onset 49 years, range 17-67 years). Fourteen patients had mMCA infarct on the left side and 16 patients on the right side. Fourteen patients had pupil dilatation before surgery. Hemicraniectomy was performed at a median of 52 h (range 13-235 h) after stroke onset. Nine patients died within 1 month after surgery because of cerebral herniation (n = 6), myocardial infarction (n = 1) or intensive care complications (n = 2). No further deaths occurred during follow-up, which was at median 3.4 years after surgery. Status for the 21 survivors at the last follow-up was: mRS 2 or less (n = 6) and mRS 3-5 (n = 15). The oldest patient with mRS 2 or less was 53 years at stroke onset. Thirteen patients (43%) could walk without substantial aid. The long-term survival after mMCA infarction treated with hemicraniectomy seems to be favourable if the patient survives the acute phase. The outcome as measured with mRS may be better among younger patients.},
  author       = {Malm, J and Bergenheim, AT and Enblad, P and Hardemark, HG and Koskinen, LOD and Naredi, S and Nordström, Carl-Henrik and Norrving, B and Uhlin, J and Lindgren, Arne},
  issn         = {1600-0404},
  language     = {eng},
  number       = {1},
  pages        = {25--30},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Neurologica Scandinavica},
  title        = {The Swedish Malignant Middle cerebral artery Infarction Study: Long-term results from a prospective study of hemicraniectomy combined with standardized neurointensive care},
  url          = {http://dx.doi.org/10.1111/j.1600-0404.2005.00537.x},
  doi          = {10.1111/j.1600-0404.2005.00537.x},
  volume       = {113},
  year         = {2006},
}