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1、Wengui Yu, Joanna Rives, Babu Welch, Jonathan White, and Duke Samson UT Southwestern Medical Center, Dallas, TX,Ipsilateral Cerebral Venous Outflow Obstruction Is Associated with Fatal Edema of MCA Infarction,Introduction,MCA infarction accounts for 10 % of ischemic stroke Approximately 40% of patie
2、nts with large MCA infarction develop fatal edema. Mortality rate of malignant MCA infarction was reported to be 88% with medical therapy.,Hemicraniectomy improves outcome of malignant MCA stroke,3 clinical trials: DECIMAL, HAMLET, and DESTINY. 93 patients randomized to surgical or medical therapy.
3、Patients 60 years of age. The timing of surgery 48 hrs after stroke onset. Outcome with mRS at 1 yr.,2007;6(3):215-22,Questions,Not every MCA stroke patient develops fatal edema. Hemicraniectomy could be associated with complications, such as intracranial hemorrhage, infection, and CSF leakage. How
4、to predict which patient will need surgery?,Prediction of the Development of Fatal Edema,Early predictors of fatal edema include infarct size, young age, female gender, NIH Stroke Scale score 20 on admission, elevated white blood cell counts, hypertension, heart failure, ipsilateral abnormal circle
5、of Willis, and carotid occlusion. Infarct size is the major determinant, but its predictive value is only moderate.,Aim of Our Study,To investigate the relevance of the ipsilateral cerebral venous sinuses in the development of fatal edema.,Methods,A retrospective study All consecutive patients with
6、large MCA infarction admitted to our Neurointensive Care Unit from January 2007 to October 2008 were included. Medical records, laboratory data, and imaging studies were analyzed. Patients with malignant MCA infarction were compared with those with non-malignant MCA infarction.,Results,Table 1. Demo
7、graphics and Clinical Features,Note: NA, normal appearance.,Table 2. Clinical features of malignant and non-malignant MCA infarction,Non-malignant MCA infarction,Day 1 2 4 5 Bilateral TS and IJ,Day 1 2 3 5 Ipsilateral hypoplasia of TS and IJ,Day 1 2 3 4 Ipsilateral atresia of TS,Malignant MCA infarc
8、tion,Conclusions,Our preliminary findings suggest that occlusive disease of the ipsilateral cerebral venous sinuses is associated with early fatal edema of MCA infarction. Anomaly of the ipsilateral cerebral venous sinuses in patients with large MCA stroke may be an indication for early hemicraniectomy.,