<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to trea...<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. <strong>Aim: </strong>To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. <strong>Methods: </strong>The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. <strong>Results: </strong>The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. <strong>Conclusion:</strong> Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.展开更多
Intracranial large vessel involvement is an unusual complication of tuberculous meningitis.The authors report a 39-year-old female presenting with an episode of seizure,followed by rapid decline in sensorium without p...Intracranial large vessel involvement is an unusual complication of tuberculous meningitis.The authors report a 39-year-old female presenting with an episode of seizure,followed by rapid decline in sensorium without prominent systemic features.An initial cranial magnetic resonance imaging revealed tuberculomata and patchy infarcts.Despite antituberculous therapy,she progressively worsened.A cranial computed tomography scan done following the worsening revealed a massive middle-cerebral artery(MCA)infarct.Unfortunately,the patient died in spite of decompressive craniotomy.Malignant MCA territory infarct is a rare and potentially fatal complication of tuberculous meningitis.展开更多
文摘<strong>Introduction:</strong> Malignant middle cerebral artery (MCA) infarction is a devastating entity that is associated with up to 80% mortality. Decompressive Hemicraniectomy has been utilized to treat brain swelling and mass effect secondary to these infarctions in an attempt to improve functional outcome. <strong>Aim: </strong>To evaluate the functional outcome of decompressive hemicraniectomy in management of malignant MCA infarctions. <strong>Methods: </strong>The study included 30 patients with malignant MCA infarctions operated upon by decompressive hemicraniectomy and duroplasty with pericranium or fascia lata graft in the period from June 2016 to January 2019. Pre-operative neurological condition, associated morbidity, location and extent of the infarction were assessed. Surgery was performed within 48 hours of the onset of stroke or 12 hours within deterioration of conscious level. Pre-operative CT scan as well as sequential post-operative CT was done. Functional outcome was assessed by the modified Rankin Scale (mRS) at the time of discharge and 3 months following surgery. <strong>Results: </strong>The study included 18 males and 12 females with a mean age of 54.7 years. The pre-operative GCS was <8 (5 - 7) in 11 patients and 8 or higher (8 - 13) in 19 patients. Good functional outcome (mRS 0 - 3) was achieved in 13 (43.3%) cases while poor outcome (mRS 4 - 5) occurred in 8 (26.7%) cases and mortality (mRS 6) occurred in 9 (30%) cases. <strong>Conclusion:</strong> Decompressive hemicraniectomy improves functional outcome in cases of malignant MCA infarction. Pre-operative GCS, age, volume of infarction, degree of midline shift, timing of surgery and associated morbidity are the most important factors affecting the outcome.
文摘Intracranial large vessel involvement is an unusual complication of tuberculous meningitis.The authors report a 39-year-old female presenting with an episode of seizure,followed by rapid decline in sensorium without prominent systemic features.An initial cranial magnetic resonance imaging revealed tuberculomata and patchy infarcts.Despite antituberculous therapy,she progressively worsened.A cranial computed tomography scan done following the worsening revealed a massive middle-cerebral artery(MCA)infarct.Unfortunately,the patient died in spite of decompressive craniotomy.Malignant MCA territory infarct is a rare and potentially fatal complication of tuberculous meningitis.
