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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Wengui Yu,Joanna Rives,Babu Welch,Jonathan White,and Duke Samson UT Southwestern Medical Center,Dallas,TX,Ipsilateral Cerebral Venous Outflow Obstruction Is Associated with Fatal Edema of MCA Infarction,Introduction,MCA infarction accounts for 10%of ischemic stroke,Approximately 40%of patients with large MCA infarction develop fatal edema.,Mortality rate of malignant MCA infarction was reported to be 88%with medical therapy.,Hemicraniectomy improves outcome of malignant MCA stroke,3 clinical trials:DECIMAL,HAMLET,and DESTINY.,93 patients randomized to surgical or medical therapy.,Patients,60 years of age.,The timing of surgery 20 on admission,elevated white blood cell counts,hypertension,heart failure,ipsilateral abnormal circle of Willis,and carotid occlusion.,Infarct size is the major determinant,but its predictive value is only moderate.,Aim of Our Study,To investigate the relevance of the ipsilateral cerebral venous sinuses in the development of fatal edema.,Methods,A retrospective study,All consecutive patients with large MCA infarction admitted to our Neurointensive Care Unit from January 2007 to October 2021 were included.,Medical records,laboratory data,and imaging studies were analyzed.,Patients with malignant MCA infarction were compared with those with non-malignant MCA infarction.,Results,Table 1.Demographics and Clinical Features,Pt,Age,Sex,Infarction,Etiology,Maximal,midline shift(mm),Ipsilateral,transverse,Sinuses(TS),Ipsilateral,internal jugular vein(IJ),mRS at discharge,1,67,m,R-MCA,Embolic,2,dominant,dominant,3,2,81,f,R-MCA,Embolic,3.4,dominant,NA,4,3,69,m,L-MCA,ICA occlusion,16.1,hypoplastic,NA,6,4,60,m,L-MCA,Embolic,4.6,NA,NA,5,5,38,m,L-MCA,ICA occlusion,6.4,NA,NA,3,6,37,m,R-MCA,Vasculitis,1,NA,NP,6,7,64,m,R-MCA,ICA dissection,16.8,NA,occluded,6,8,46,m,L-MCA,ICA dissection,1.9,dominant,dominant,3,9,70,f,R-MCA/ACA,ICA occlusion,24.3,atresic,hypoplastic,6,10,54,m,R-MCA,Embolic,7.2,NA,NP,3,11,60,f,R-MCA,ICA occlusion,9.8,NA,NP,5,12,48,f,R-MCA,ICA occlusion,12.7,hypoplasia,hypoplasia,6,13,67,m,R-MCA,ICA stenosis,16.6,NA,NA,4,14,47,m,R-MCA,Embolic,6.3,NA,NA,3,Note,:NA,normal appearance.,Table 2.Clinical features of malignant and non-malignant MCA infarction,Non-malignant MCA Infarction,Malignant MCA Infarctio,n,#of patients,9,5,Age(y),54.4 14.9,58.8 10(p=0.422),Female,n(%),2(22.2%),2(40%),R MCA,n(%),6(66.7%),4(80%),Infarction volume,196 70,327 36(p0.001),Maximal midline shift,4.7 3.1,17.3 4.9(p0.001),Ipilateral TS or IJ,Atresia or occlusion,0,2(40%),Hypoplasia,0,2(40%,Mortality rate(%),0%,80%,Non-malignant MCA infarction,Day 1 2 4 5 Bilateral TS and IJ,Day 1 2 3 5 Ipsilateral hypoplasia of TS and IJ,Day 1 2 3 4 Ipsilateral atresia of TS,Malignant MCA infarction,Conclusions,Our preliminary findings suggest that occlusive disease of the ipsilateral cerebral venous sinuses is associated with early fatal edema of MCA infarction.,Anomaly of the ipsilateral cerebral venous sinuses in patients with large MCA stroke may be an indication for early hemicraniectomy.,
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