Malignant middle cerebral artery (MCA) infarction: Pathophysiology, diagnosis and management

Postgraduate Medical Journal

Volumn 86, Issue 1014, 2010, Pages 235-242

  Treadwell, Sean D ^a   Thanvi, Bhomraj ^b  

^a LEICESTER GENERAL HOSPITAL   (United Kingdom)

^b SOUTH WARWICKSHIRE NHS FOUNDATION TRUST   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

BARBITURIC ACID DERIVATIVE; CORTICOSTEROID; GLYCEROL; MANNITOL; SODIUM CHLORIDE; TROMETAMOL;

BRAIN EDEMA; CEREBRAL ARTERY DISEASE; CLINICAL FEATURE; COMPUTER ASSISTED TOMOGRAPHY; CRANIECTOMY; DECOMPRESSION SURGERY; HEAD POSITION; HUMAN; HYPERVENTILATION; INDUCED HYPOTHERMIA; NEUROIMAGING; NUCLEAR MAGNETIC RESONANCE IMAGING; OUTCOME ASSESSMENT; PATHOPHYSIOLOGY; PROGNOSIS; REVIEW; SINGLE PHOTON EMISSION COMPUTER TOMOGRAPHY; INFARCTION, MIDDLE CEREBRAL ARTERY; INTRACRANIAL HYPERTENSION; PATIENT POSITIONING; PROCEDURES; STROKE;

BRAIN EDEMA; DECOMPRESSION, SURGICAL; HUMANS; INFARCTION, MIDDLE CEREBRAL ARTERY; INTRACRANIAL HYPERTENSION; PATIENT POSITIONING; STROKE; TOMOGRAPHY, EMISSION-COMPUTED, SINGLE-PHOTON; TOMOGRAPHY, X-RAY COMPUTED;

EID: 77950856731     PISSN: 00325473     EISSN: 14690756     Source Type: Journal    
DOI: 10.1136/pgmj.2009.094292     Document Type: Review

References (93)

1. White DB, Norris JW, Hachinski VC. Death in early stroke: causes and mechanisms. Stroke 1979;10:743.
2. Ng LK, Nimmannitya J. Massive cerebral infarction with severe brain swelling: a clinicopathological study. Stroke 1970;1:158-63.
3. Bounds JV, Wiebers DO, Whisnant JP, et al. Mechanisms and timing of deaths from cerebral infarction. Stroke 1981;12:474-77.
4. Balzer B, Stober T, Huber G, et al. Space-occupying cerebral infarct. Nervenarzt 1987;58:689-91.
5. Hacke W, Schwab S, Horn M, et al. 'Malignant' middle cerebral artery territory infarction. Arch Neurol 1996;53:309-15.
6. Kimelberg HK. Current concepts of brain edema. Review of laboratory investigations. J Neurosurg 1995;83:1051-59.
7. Go KG. The normal and pathological physiology of brain water. Adv Tech Stand Neurosurg 1997;23:47-142.
8. Sweeney MI, Yager JY, Walz W, et al. Cellular mechanisms involved in brain ischemia. Can J Physiol Pharmacol 1995;73:1525-35. (Pubitemid 26048613)
9. Choi DW. Excitotoxic cell death. J Neurobiol 1992;23:1261-76.
10. Barros LF, Castro J, Bittner CX. Ion movements in cell death: from protection to execution. Biol Res 2002;35:209-14. (Pubitemid 35189794)
11. Stiefel MF, Marmarou A. Cation dysfunction associated with cerebral ischemia followed by reperfusion: a comparison of microdialysis and ion-selective electrode methods. J Neurosurg 2002;97:97-103. (Pubitemid 34693706)
12. Kniesel U, Wolburg H. Tight junctions of the blood-brain barrier. Cell Mol Neurobiol 2000;20:57-76. (Pubitemid 30090916)
13. Westergaard E. The blood-brain barrier to horseradish peroxidise under normal and experimental conditions. Acta Neuropathol 1977;39:181-7. (Pubitemid 8166972)
14. Cole DJ, Matsumura JS, Drummond JC, et al. Time- and pressure-dependent changes in blood-brain barrier permeability after temporary middle cerebral artery occlusion in rats. Acta Neuropathol 1991;82:266-73.
15. Asahi M, Wang X, Mori T, et al. Effects of matrix metalloproteinase- 9 gene knockout on the proteolysis of blood-brain barrier and white matter components after cerebral ischemia. J Neurosci 2001;21:7724-32. (Pubitemid 32904971)
16. Fukuda S, Fini CA, Mabuchi T, et al. Focal cerebral ischemia induces active proteases that degrade microvascular matrix. Stroke 2004;35:998-1004. (Pubitemid 38419817)
17. Iadecola C, Zhang F, Casey R, et al. Inducible nitric oxide synthase gene expression in vascular cells after transient focal cerebral ischemia. Stroke 1996;27:1373-80. (Pubitemid 26286171)
18. Weis SM, Cheresh DA. Pathophysiological consequences of VEGF induced vascular permeability. Nature 2005;437:497-504. (Pubitemid 41613541)
19. Lee KR, Colon GP, Betz AL, et al. Edema from intracerebral hemorrhage: the role of thrombin. J Neurosurg 1996;84:91-6.
20. Qureshi AI, Suarez JI, Yahia AM, et al. Timing of neurologic deterioration in massive middle cerebral artery infarction: a multicenter review. Crit Care Med 2003;31:272-7.
21. Thanvi B, Treadwell SD, Robinson T. Early neurologic deterioration in acute ischaemic stroke: predictors, mechanisms, and management. Postgrad Med J 2008;84:412-17.
22. Sacco RL. Risk factors and outcomes for ischemic stroke. Neurology 1995;45(Suppl 1):10-14.
23. Kasner SE, Demchuk AM, Berrouschot J, et al. Predictors of fatal brain edema in massive hemispheric ischemic stroke. Stroke 2001;32:2117-23. (Pubitemid 32868110)
24. Ropper AH, Shafran B. Brain edema after stroke: clinical syndrome and intracranial pressure. Arch Neurol 1984;41:26-9. (Pubitemid 14214304)
25. Berrouschot J, Sterker M, Bettin S, et al. Mortality of space-occupying ('malignant') middle cerebral artery infarction under conservative intensive care. Intensive Care Med 1998;24:620-3. (Pubitemid 28344766)
26. Krieger DW, Demchuk AM, Kasner SE, et al. Early clinical and radiological predictors of fatal brain swelling in ischemic stroke. Stroke 1999;30:287-92.
27. von Kummer R, Meyding-Lamade U, Forsting M, et al. Sensitivity and prognostic value of early CT in occlusion of the middle cerebral artery trunk. AJNR Am J Neuroradiol 1994;15:9-15. (Pubitemid 24033484)
28. Pullicino PM, Alexandrov AV, Shelton JA, et al. Mass effect and death from severe acute stroke. Neurology 1997;49:1090-5.
29. Ryoo JW, Na DG, Kim SS, et al. Malignant middle cerebral artery infarction in hyperacute ischemic stroke: evaluation with multiphasic perfusion computed tomography maps. J Comput Assist Tomogr 2004;28:55-62.
30. Berrouschot J, Barthel H, von Kummer R, et al. 99m technetium-ethyl- cysteinatedimer single-photon emission CT can predict fatal ischemic brain edema. Stroke 1998;29;2556-62. (Pubitemid 28544006)
31. Oppenheim C, Sampson Y, Manai R, et al. Prediction of malignant middle cerebral artery infarction by diffusion-weighted imaging. Stroke 2000;31:2175-81.
32. Thomalla GJ, Kucinski T, Schoder V, et al. Prediction of malignant middle cerebral artery infarction by early perfusion- and diffusion-weighted magnetic resonance imaging. Stroke 2003;34:1892-900. (Pubitemid 36944776)
33. Feldman Z, Kanter MJ, Robertson CS, et al. Effect of head elevation on intracranial pressure, cerebral perfusion pressure and cerebral blood flow in head-injured patients. J Neurosurg 1992;76:207-11.
34. Rosner MJ, Coley IB. Cerebral perfusion pressure, intracranial pressure, and head elevation. J Neurosurg 1986;65:636-41. (Pubitemid 17177512)
35. Schwarz S, Georgiadis D, Aschoff A, et al. Effects of body position on intracranial pressure and cerebral perfusion in patients with large hemispheric stroke. Stroke 2002;33:497-501. (Pubitemid 34123395)
36. Stocchetti N, Maas AI, Chieregato A, et al. Hyperventilation in head injury: A review. Chest 2005;127:1812-27. (Pubitemid 46218813)
37. Imberti R, Bellinzona G, Langer M. Cerebral tissue Po2 and SJVo2 changes during moderate hyperventilation in patients with severe traumatic brain injury. J Neurosurg 2002;96:97-102. (Pubitemid 34229993)
38. Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcome: a meta-analysis of studies in patients. Stroke 2000;31:410-14. (Pubitemid 30078174)
39. Karibe H, Chen J, Zarow GJ, et al. Delayed induction of mild hypothermia to reduce infarct volume after temporary middle cerebral artery occlusion in rats. Neurosurgery 1994;80:112-19. (Pubitemid 24020713)
40. Morikawa E, Ginsberg MD, Dietrich WD, et al. The significance of brain temperature in focal cerebral ischemia: histopathological consequences of middle cerebral artery occlusion in the rat. J Cereb Blood Flow Metab 1992;12:380-9.
41. Safar P, Klain M, Tisherman S. Selective brain cooling after cardiac arrest. Crit Care Med 1996;24:911-14. (Pubitemid 26189926)
42. Metz C, Holzschuh M, Bein T, et al. Moderate hypothermia in patients with severe head injury: cerebral and extracerebral effects. J Neurosurg 1996;85:533-41. (Pubitemid 26315182)
43. Rohrer MJ, Natale AM. Effect of hypothermia on the coagulation cascade. Crit Care Med 1992;20:1402-5.
44. Schwab S, Schwarz S, Spranger M, et al. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke 1998;29:2461-6. (Pubitemid 28543990)
45. Georgiadis D, Schwarz S, Aschoff A, et al. Hemicraniectomy and moderate hypothermia in patients with severe ischemic stroke. Stroke 2002;33:1584-8. (Pubitemid 34619962)
46. Schwab S, Georgiadis D, Berrouschot J, et al. Feasibility and safety of moderate hypothermia after massive hemispheric infarction. Stroke 2001;32:2033-5. (Pubitemid 32868093)
47. Georgiadis D, Schwarz S, Kollmar R, et al. Endovascular cooling for moderate hypothermia in patients with acute stroke: First results of a novel approach. Stroke 2001;32:2550-3. (Pubitemid 33055304)
48. Milhaud D, Thouvenot E, Heroum C, et al. Prolonged moderate hypothermia in massive hemispheric infarction: Clinical experience. J Neurosurg Anesthesiol 2005;17:49-53. (Pubitemid 40070587)
49. Weed LH, McKibben PS. Experimental alteration of brain bulk. Am J Phys 1919;48:531-55.
50. Paczynski RP. Osmotherapy. Basic concepts and controversies. Crit Care Clin 1997;13:105-29.
51. Videen TO, Zazulia AR, Manno EM, et al. Mannitol bolus preferentially shrinks non-infarcted brain in patients with ischemic stroke. Neurology 2001; 57:2120-2.
52. Jeevaratnam DR, Menon DK. Survey of intensive care of severely head injured patients in the United Kingdom. BMJ 1996;312:994-7.
53. Alvarez B, Ferrer-Sueta G, Radi R. Slowing of peroxynitrite decomposition in the presence of mannitol and ethanol. Free Radic Biol Med 1998;24:1331-7. (Pubitemid 28246750)
54. Korenkov AI, Pahnke J, Frei K, et al. Treatment with nimodipine or mannitol reduces programmed cell death and infarct size following focal cerebral ischemia. Neurosurg Rev 2000;23:145-50.
55. Diringer MN, Zazulia AR. Osmotic therapy: fact and fiction. Neurocrit Care 2004;1:219-33.
56. Mendelow AD, Teasdale GM, Russell T, et al. Effect of mannitol on cerebral blood flow and cerebral perfusion pressure in human head injury. J Neurosurg 1985;63:43-8. (Pubitemid 15067271)
57. Muizelaar JP, Lutz HA III, Becker DP. Effect of mannitol on ICP and CBF and correlation with pressure autoregulation in severely head-injured patients. J Neurosurg 1984;61:700-76.
58. James HE, Langfitt TW, Kumar VS, et al. Treatment of intracranial hypertension. Analysis of 105 consecutive, continuous recordings of intracranial pressure. Acta Neurochir 1977;36:189-200.
59. Paczynski RP, He YY, Diringer MN, et al. Multiple-dose mannitol reduces brain water content in a rat model of cortical infarction. Stroke 1997;28:1437-43.
60. Kaufmann AM, Cardoso ER. Aggravation of vasogenic cerebral edema by multipledose mannitol. J Neurosurg 1992;77:584-9.
61. Manninen PH, Lam AM, Gelb AW, et al. The effect of high dose mannitol on serum and urine electrolytes and osmolality in neurosurgical patients. Can J Anaesth 1987;34:442-6.
62. Bereczki D, Mihalka L, Szatmari S, et al. Mannitol use in acute stroke: case fatality at 30 days and 1 year. Stroke 2003;34:1730-5. (Pubitemid 36842636)
63. Bereczki D, Liu M, Fernandes do Prado G, et al. Mannitol for acute stroke. Cochrane Database Syst Rev 2007;(1):CD001153.
64. Adams HP Jr, del Zoppo G, Alberts MJ, et al. American Heart Association; American Stroke Association Stroke Council; Clinical Cardiology Council; Cardiovascular Radiology and Intervention Council; Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007;38:1655-711.
65. Mirski AM, Denchev ID, Schnitzer SM, et al. Comparison between hypertonic saline and mannitol in the reduction of elevated intracranial pressure in a rodent model of acute cerebral injury. J Neurosurg Anesthesiol 2000;12:334-44.
66. Berger S, Schurer L, Hartl R, et al. Reduction of post-traumatic intracranial hypertension by hypertonic/hyperoncotic saline/dextran and hypertonic mannitol. Neurosurgery 1995;37:98-107.
67. Qureshi AI, Wilson DA, Traystman RJ. Treatment of elevated intracranial pressure in experimental intracerebral hemorrhage: comparison between mannitol and hypertonic saline. Neurosurgery 1999;44:1055-63.
68. Vialet R, Albanese J, Thomachot L, et al. Isovolume hypertonic solutes (sodium chloride or mannitol) in the treatment of refractory posttraumatic intracranial hypertension: 2 mL/kg 7.5% saline is more effective than 2 mL/kg 20% mannitol. Crit Care Med 2003;31:1683-7. (Pubitemid 36714221)
69. Harutjunyan L, Holz C, Rieger A, et al. Efficiency of 7.2% hypertonic saline hydroxyethyl starch 200/0.5 versus mannitol 15% in the treatment of increased intracranial pressure in neurosurgical patientsda randomized clinical trial [ISRCTN62699180]. Crit Care 2005;9:530-40.
70. Schwarz S, Georgiadis D, Aschoff A, et al. Effects of hypertonic (10%) saline in patients with raised intracranial pressure after stroke. Stroke 2002;33:136-40. (Pubitemid 34055759)
71. Sakamaki M, Igarashi H, Nishiyama Y, et al. Effect of glycerol on ischemic cerebral edema assessed by magnetic resonance imaging. J Neurol Sci 2003;209:69-74. (Pubitemid 36398680)
72. Righetti E, Celani MG, Cantisani T, et al. Glycerol for acute stroke. Cochrane Database Syst Rev 2004;(2):CD000096. (Pubitemid 40054199)
73. Akioka T, Ota K, Matsumato A, et al. The effects of THAM on intracranial hypertension. An experimental and clinical study. In: Beks JWF, Bosch DA, Brock M, eds. Intracranial pressure III. Berlin: Springer-Verlag, 1976: 219-22.
74. Nagao S, Kitaoka T, Fujita K, et al. Effect of tris- (hydroxymethyl)- aminomethane on experimental focal cerebral ischemia. Exp Brain Res 1996;111:51-6. (Pubitemid 26300808)
75. Wolf AL, Levi L, Marmarou A, et al. Effect of THAM upon outcome in severe head injury: A randomized prospective clinical trial. J Neurosurg 1993;78:54-9. (Pubitemid 23005353)
76. Ward JD, Becker DP, Miller JD, et al. Failure of prophylactic barbiturate coma in the treatment of severe head injury. J Neurosurg 1985;62:383-8. (Pubitemid 15142184)
77. Eisenberg HM, Frankowski RF, Contant CF, et al. High-dose barbiturate control of elevated intracranial pressure in patients with severe head injury. J Neurosurg 1988;69:15-23.
78. Schwab S, Spranger M, Schwarz S, et al. Barbiturate coma in severe hemispheric stroke: useful or obsolete? Neurology 1997;48:1608-13. (Pubitemid 27290773)
79. Sinha S, Bastin ME, Wardlaw JM, et al. Effects of dexamethasone on peritumoral oedematous brain: a DT-MRI study. J Neurol Neurosurg Psychiatr 2004;75:1632-5. (Pubitemid 39430624)
80. Slivka AP, Murphy EJ. High-dose methylprednisolone treatment in experimental focal cerebral ischemia. Exp Neurol 2001;167:66-172.
81. Qizilbash N, Lewington SL, Lopez-Arrieta JM. Corticosteroids for acute ischaemic stroke. Cochrane Database Syst Rev 2002;(2):CD000064.
82. Cushing H. The establishment of cerebral hernia as a decompressive measure for inaccessible brain tumors; with the description of intermuscular methods of making the bone defect in temporal and occipital regions. Surg Gynecol Obstet 1905;1:297.
83. Scarcella G. Encephalomalacia simulating the clinical and radiological aspects of brain tumor; a report of 6 cases. J Neurosurg 1956;13:278-92.
84. Schwab S, Steiner T, Aschoff A, et al. Early hemicraniectomy in patients with complete middle cerebral artery infarction. Stroke 1998;29:1888-93. (Pubitemid 28399983)
85. Walz B, Zimmermann C, Bottger S, et al. Prognosis of patients after hemicraniectomy in malignant middle cerebral artery infarction. J Neurol 2002;249:1183-90. (Pubitemid 35025091)
86. Leonhardt G, Wilhelm H, Doerfler A, et al. Clinical outcome and neuropsychological deficits after right decompressive hemicraniectomy in MCA infarction. J Neurol 2002;249:1433-40. (Pubitemid 35217668)
87. Koh M, Goh K, Tung MYY, et al. Is decompressive craniectomy for acute cerebral infarction of any benefit? Surg Neurol 2000;53:225-30. (Pubitemid 30201526)
88. Rieke K, Schwab S, Krieger D, et al. Decompressive surgery in space occupying hemispheric infarction: results of an open, prospective trial. Crit Care Med 1995;23:1576-87.
89. Vahedi K, Vicaut E, Mateo J, et al. Sequential-design, multicenter, randomized, controlled trial of early decompressive craniectomy in malignant middle cerebral artery infarction (DECIMAL Trial). Stroke 2007;38:2506-17. (Pubitemid 47329630)
90. Juttler E, Schwab S, Schmiedek P, et al. Decompressive Surgery for the Treatment of Malignant Infarction of the Middle Cerebral Artery (DESTINY): a randomized, controlled trial. Stroke 2007;38:2518-25. (Pubitemid 47329631)
91. Hofmeijer J, Kappelle LJ, Algra A, et al. Surgical decompression for spaceoccupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 2009;8:326-33.
92. Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 2007;6:215-22. (Pubitemid 46237760)
93. National Collaborating Centre for Chronic Conditions. Stroke: national clinical guideline for diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). London: Royal College of Physicians, 2008.