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Massive Cerebral Infarction

Subramaniam, Suresh MD, MSc*; Hill, Michael D. MD, MSc, FRCPC*†

doi: 10.1097/01.nrl.0000159987.70461.d7
Original Article

Background: Massive cerebral infarcts cause brain edema with midline shifts and impingement on vital structures producing coma and death. The mortality rate is estimated at 80% with standard medical treatment. Surgical decompression with hemicraniectomy has proved to be life saving, but the impact on functional outcomes is largely unknown. The focus of this review is to discuss the treatment options for massive cerebral infarcts.

Review Summary: Neurologic deterioration following massive cerebral infarct needs to be recognized early enough for medical and surgical interventions. Medical management includes monitoring in a neurologic intensive care unit, hyperosmolar agents, and hyperventilation. Surgical management includes decompressive hemicraniectomy and duraplasty with resection of infarcted tissue in some instances.

Conclusion: Hemicraniectomy is emerging as a promising treatment of patients with massive cerebral infarcts, but only select patients benefit from this procedure. Further information from randomized controlled trials is required to elucidate the best treatment options for this kind of stroke.

From the *Calgary Stroke Program, Department of Clinical Neurosciences, and the †Departments of Medicine and Community Health Sciences, University of Calgary, Alberta, Canada.

Reprints: Michael D. Hill, MD, MSc, FRCPC, Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary, Foothills Hospitals, Room 1242A, 1403 29th Street NW, Calgary, Alberta, T2N 2T9 Canada. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.