Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care - PubMed (original) (raw)

Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care

J Berrouschot et al. Intensive Care Med. 1998 Jun.

Abstract

Objective: To find what the mortality rate of space-occupying ('malignant') middle cerebral artery (MCA) infarction is under maximum conservative intensive care. To establish whether any early indicators of survival exist.

Design: Prospective descriptive study.

Setting: Neuro-critical care unit of a university hospital.

Patients: Fifty-three patients (mean age 64 +/- 10 years) with 'malignant' MCA infarction.

Interventions: Maximum conservative intensive care using a standardized protocol (heparin, osmotherapy, tromethamol, mild hyperventilation). The start of therapy was within 12 h after the onset of symptoms.

Measurements and results: The Glasgow Coma Scale (GCS) and Scandinavian Stroke Scale (SSS) were recorded daily. A computed tomography (CT) scan was performed on admission, on day 3 and on day 7. SSS, Barthel Index and Rankin Scale of the surviving patients were recorded after 3 months. On admission, the mean GCS was 13 +/- 3 points and mean SSS 18 +/- 7 points. All patients had to undergo mechanical ventilation (23 +/- 26 h after the onset of symptoms) and were comatose after 28 +/- 30 h. Of 53 patients, 37 (70%) suffered brain death in the intensive care unit (ICU) after an average of 90 +/- 59 h. After 3 months 42/53 (79 %) patients had died. The Barthel Index of the surviving patients was 54 +/- 12 points, the SSS 25 +/- 9 points and the Rankin Scale 3 +/- 1 points. The deceased patients had a significantly higher body temperature on admission than the surviving patients (36.8 degrees C vs 36.3 degrees C).

Conclusions: The mortality of patients with 'malignant' MCA infarction is very high despite maximum conservative intensive care.

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References

1. 1. J Neurosurg. 1989 Oct;71(4):498-502 - PubMed
2. 1. Arch Neurol. 1984 Jan;41(1):26-9 - PubMed
3. 1. Lancet. 1996 Feb 17;347(8999):422-5 - PubMed
4. 1. Crit Care Med. 1995 Sep;23(9):1576-87 - PubMed
5. 1. Curr Opin Neurol. 1994 Feb;7(1):11-9 - PubMed

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