Infarto hemisférico maligno de la arteria cerebral media. Consideraciones diagnósticas y opciones terapéuticas

Translated title of the contribution: Malignant hemispheric infarction of the middle cerebral artery. Diagnostic considerations and treatment options

D. Godoy, G. Piñero, S. Cruz-Flores, G. Alcalá Cerra, A. Rabinstein

Research output: Contribution to journalShort survey

5 Scopus citations

Abstract

Introduction: Malignant hemispheric infarction (MHI) is a specific and devastating type of ischemic stroke. It usually affects all or part of the territory of the middle cerebral artery although its effects may extend to other territories as well. Its clinical outcome is frequently catastrophic when only conventional medical treatment is applied. Objective: The purpose of this review is to analyse the available scientific evidence on the treatment of this entity. Development: MHI is associated with high morbidity and mortality. Its clinical characteristics are early neurological deterioration and severe hemispheric syndrome. Its hallmark is the development of space-occupying cerebral oedema between day 1 and day 3 after symptom onset. The mass effect causes displacement, distortion, and herniation of brain structures even when intracranial hypertension is initially absent. Until recently, MHI was thought to be fatal and untreatable because mortality rates with conventional medical treatment could exceed 80%. In this unfavourable context, decompressive hemicraniectomy has re-emerged as a therapeutic alternative for selected cases, with reported decreases in mortality ranging between 15% and 40%. Conclusions: In recent years, several randomised clinical trials have demonstrated the benefit of decompressive hemicraniectomy in patients with MHI. This treatment reduces mortality in addition to improving functional outcomes.

Translated title of the contributionMalignant hemispheric infarction of the middle cerebral artery. Diagnostic considerations and treatment options
Original languageSpanish
Pages (from-to)332-343
Number of pages12
JournalNeurologia
Volume31
Issue number5
DOIs
StatePublished - Jun 1 2016

Keywords

  • Cerebral infarction
  • Cerebral oedema
  • Decompressive hemicraniectomy
  • Ischaemic stroke
  • Malignant infarction

ASJC Scopus subject areas

  • Clinical Neurology

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