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Recommendations for management of large hemispheric infarction

Zha, Alicia M.a; Sari, Murata; Torbey, Michel T.a,b

Current Opinion in Critical Care: April 2015 - Volume 21 - Issue 2 - p 91–98
doi: 10.1097/MCC.0000000000000184
NEUROSCIENCE: Edited by Michael N. Diringer

Purpose of review Large hemispheric infarction is a devastating disease that continues to be associated with significant mortality and morbidity. Most often these patients are admitted to the ICU requiring significant physician and nursing resources. This review will address some of the ICU management issues and review the evidence supporting medical and surgical management of malignant cerebral edema.

Recent findings The most recent changes in management of large hemispheric infarct include the American Heart Association and Neurocritical Care Guidelines. These guidelines address airway management and mechanical ventilation, blood pressure control, fluid management, and glucose and temperature control. In addition, they addressed the indication for surgical management of cerebral edema. We review the recent guidelines updates and trials of surgical management of large hemispheric infarcts.

Summary Large hemispheric infarcts continue to have significant morbidity and mortality. Recent guidelines have provided an excellent framework to help intensivists manage these complicated patients. Recent surgical data continue to support early hemicraniectomy even in elderly patients.

aDepartment of Neurology

bDepartment of Neurosurgery, The Ohio State University College of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA

Correspondence to Michel T. Torbey, MD, MPH, FNCS, FCCM, FAHA, Professor of Neurology and Neurosurgery, Director, Cerebrovascular and Neurocritical Care Division, The Ohio State University Wexner Medical Center, 395 W 12th Ave 7th Floor, Columbus, OH 43210, USA. Tel: +1 614 293 4966; e-mail:

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